
Glass _ 



Book 



COPYRICHT DEPOSIT 



DIAGNOSIS 



OF 



SYPHILIS 






By 
GEORGE E. MALSBARY, M. D. 



Professor of Medicine Cincinnati Polyclinic 
and Post-Graduate School, Author of a 
"Text-book on the Practice of Medicine," 
and Monographs on "Treatment of Tuber- 
culosis," "The Rheumatisms," "The 
Septic Infections," "Meningitis" and 
"Cerebro-spinal Meningitis" (in 
Wood's "Reference Handbook of 
the Medical Sciences"), Member 
of the Academy of Medicine of 
Cincinnati, The American 
Medical Association, The 
Cincinnati Obstetrical 
Society, etc. 



CINCINNATI 

HARVEY PUBLISHING COMPANY 

1911 






Copyright, 1910, 

BY 

Harvey Publishing Co. 



&CLAS73114 



PREFACE 



A PHYSICIAN in practice soon becomes deeply impressed with 
the great diagnostic importance of the recognition of syphi- 
lis. No disease may present greater diversity in appearance and 
symptomatology. Syphilis may involve practically every organ 
and tissue in the body. Hence, the disease is of diagnostic 
interest to medical men, whether they be in general or special 
practice. 

The diagnosis of syphilis has recently been illuminated by 
the discovery of the cause of the disease. The recognition of the 
spirochete pallida and the elaboration of the serum test, enable 
us to make a clear diagnosis in many cases that otherwise 
would remain obscure. In this work, the fact is emphasized 
that laboratory work supplements rather than supplants the 
clinical diagnosis. But the laboratory has proved a most valu- 
able adjunct, practically revolutionizing diagnosis in the cases 
that were formerly most difficult to recognize. 

This volume is based upon notes collected during a number 
of years, and an exhaustive study of the literature. Those 
who have attempted such a project will best appreciate the her- 
culean task involved in describing the kaleidoscopic picture 
that may be presented by syphilis, and the difficulties encoun- 
tered in selecting and arranging the points of diagnostic im- 
portance so that they may be found reliable in the elucidation 
of so complex a subject. 

In this work the subject is considered from various stand- 
points. First, attention is paid to laboratory diagnosis, special 
stress being placed upon the methods of recognition of the 
spirochete pallida, and the technic and relative value of the 
"Wassermann and other serum tests. Second, hereditary syphi- 
lis has received ample consideration. Third, the acquired form 
of syphilis is discussed in its various stages. Fourth, the syphi- 
litic affections of the various organs has received detailed de- 
scription. Fifth, there is appended an extensive recent bibli- 
ography bearing upon the subject. 

G. E. M. 



TABLE OF CONTENTS 



Page 
Synonyms — Definition 1 

Bacteriology 1 

Microorganisms in syphilis — Lustgarten bacillus — Syphilitic virus — 

Schaudinn — Hoffman — Spirochete pallida — Dark ground illumination — 

Giemsa stain — Marino stain — Proca stain — Goldhorn stain — Grunwald stain 

— Ghoreyer osmic acid stain — Spirochete refrigerans. 
Tissue setions — Levaditi stain. 
Spirochetes in the blood — Richards and Hunt — Acetic acid method — 

Flagella stain. 

The Serum Diagnosis of Syphilis 9 

Relative value — Principles of reaction — Complement — Amboceptor — 
Antigen — -Complement deviation — Wassermann's theory — Inconsistencies, 
apparent and real — Wasserman's reaction — Porges-Meier test — Noguchi 
test — Klausner test — Mayer and Proescher test — Fleming test — Brieger 
test — Results of serum reactions — Reaction in milk — Reaction post-mortem 
— meiostagnin reaction. 

Bibliography of Spirochete Pallida and Serum Reaction.... 17 

Methods of Infection 31 

Inoculation — Sexual transmission — Surgical and obstetric infection — 

Infection through kissing — Common utensils and vessels — Watercloset 

Infection — Infection of physicians and nurses — Unclean circumcision. 

Hereditary syphilis — Inheritance from mother — Inheritance from 

father — nursing syphilitic child — Colles' law. 

Hereditary Syphilis 32 

Hereditary syphilis — Congenital syphilis — Difference from acquired 
syphilis — Profeta's law — Congenital immunity — Syphilis hereditaris tarda 
— History of syphilis in parents — Spirochete pallida — Wassermann reaction 
— Abortions due to syphilis — Fertility of syphilitics — Transmission by father 
— Persistence of syphilis — Latent syphilis — Vaccinal syphilis — Idiocy and 
mental failure in hereditary syphilis — Paralytic dementia — Locomotor 
ataxia — Transmission to third generation — Mortality. 

Diagnosis of syphilis of fetus in utero. 

Diagnosis of syphilis in abortion. 

Diagnosis of syphilis at time of birth — Senile appearance — Hoarseness 
— Coryza — Eruptions. 

Diagnosis at birth or soon after — Peevishness and irritability — Icterus 
neonatorum — Harsh and difficult breathing — Snuffles — Sore mouth — Im- 
paired digestion — Emaciation — Senile appearance — Eruptions. 

V 






vi Table of Contents. 

Diagnosis during first year — Nocturnal peevishness and irritability — 
Hoarseness — Harsh and difficult breathing — Coryza — Eruptions — Erythema 
— Papules — Pustules — Mucous patches — Emaciation — Senile appearance — 
Visceral affections — Termination at end of second stage — Quiescence — Mal- 
nutrition — Stunted growth — Retarded development. 

Later symptoms of hereditary syphilis — Hutchinson teeth — Condylo- 
mata — Sores or pseudo-scars — Iritis — Choroides areolaris — Affection of 
bones — Eruption — Middle ear — Eustachian tube — Auditory nerve — Gastro- 
intestinal disturbances — Dactylitis. 

Syphilis tarda. 

ACQUIRED SYPHIXIS. 

Incubation 38 

Length of period of incubation. 

First Stage of Syphilis 38 

Diagnostic tripod: Incubation, induration, adenopathy — Varieties of 
induration — Absence of induration — Shape of induration — Other causes 
of induration. 

Chancre — Diagnostic table — Incubation — Derivation — Early appearance 
— Necrosis — Induration — Shape — Single and multiple — Secretion — Pain and 
discomfort — Adenopathy — Duration center of infection — Therapeutic test — 
Resolution — Spirochete pallida — Wassermann reaction — Non-syphilitic 
scars. 

Extra-genital infection — Mouth- — Tongue — Gums — Tonsils — Palate — 
Chin — Nose — Eyelids — Conjunctiva — Breast — Ear — Forehead — Extremities 
— Hands — Fingers — Toes — Anus. 

Chancre absent or obscured — Indurated edema. 

Genital syphilis — Male — Female. 

Adenopathies — Indolent buboes — Time of appearance — Suppuration — 
Location in genital syphilis — In extra-genital syphilis — Lymphatic vessels. 

Chancre in hairy regions — Scalp — Beard — Mustache — Due to razor 
cuts — Vaccino-syphilis — Mammary glands — Tonsils and fauces — Forearm 
—Thigh. 

Chancre and chancroid — Differential diagnosis — Confrontation — Incu- 
bation — Location — Early appearance — Multiple inoculations — Shape — Ulcer 
— Secretion — Induration — Pain — Course — Adenopathies — Lymphatic vessels 
— Resolution — Therapeutic test — Spirochete pallida — Wassermann reaction. 

Epithelioma and chancre — Ulcerating gumma and chancre — Simple 
abrasions with ulceration — Herpes progenitalis. 

Second Stage of Syphilis 47 

Second incubation period — Abnormal incubation. 

Fever — Chill — Headache — Malaise — General depression — Weakness — 
Rheumatoid pains — Appetite-eruption — Anemia — Leucocytosis — Pernicious 
anemia — Wassermann reaction — Spirochete pallida — Cutaneous and mucous 
lesions. 



Table of Contents. vii 

Syphilides — Differentiation from non-syphilitic macules, papules, 
nodules, pustules, ulcers. 

Characteristics of syphilides — Hyperemia — Cellular infiltration. 

Primary and modified forms of syphilides. 

General symptoms during second stage of syphilis. 

Appearance at time of eruption of syphilides — Initial lesion — Indura- 
tion of glands — Adenopathy — Alopecia — Mucous patches. 

Later symptoms of second stage — Pains in hones — Bone lesions — 
Permanent alopecia — Cicatrices. 

Color of syphilides. 

Variety of lesions during first year — Evolution of syphilis — Early 
eruptions — Pain — Itching. 

Falling of hair — Affections of nails. 

Mucous patches — Affections of the eye. 

Spirochete pallida — Wassermann reaction. 

Third Stage of Syphilis 52 

Skin eruptions — Gummatous growths — Amyloid degeneration. 

Gummata. 

Spirochete pallida — Wassermann reaction. 

SYPHILITIC AFFECTIONS OF THE VARIOUS ORGANS. 

Skin and Mucous Membranes 53 

Syphilides — Macular syphilides — Pigmentary syphilides — Papular 
syphilides — Dry papules — Lenticular papules, giant papules, miliary 
papules — Moist papules, condylomata — Variations of papular syphilides: 
Vesicular syphilides, hemorrhagic syphilides, squamous syphilides, pustular 
syphilides. 

Macula syphilides — Time of appearancee — Location — Concomitant 
symptoms of syphilis — Differentiation from measles, ruhella, scarlet fever, 
drug eruptions, roseola balsamica, urticaria, tinea versicolor, non-syphilitic 
erythemata, tinea circinata, smallpox, macules produced by pediculi, and 
cutis marmorata livida. 

Pigmentary syphilides — Variations in color — Occurrence — Location — 
Duration — Distribution — Differentiation from chloasma, vitiligo and leuco- 
derma, and tinea versicolor. 

Papular syphilides — dry papules — distribution. 

Moist papules, condylomata — distribution. 

Small acuminate papules, differentiation from scabies, lichen planus, 
lichen pilaris, lichen scrofulosum, and punctate psoriasis. 

Giant papules — Lichen syphiliticus. 

Psoriasis palmaris. 

Moist papules — External genitals — Genitalcrural folds — Anus — Navel 
— Axilla — Pendulous breast — Toes — Ear. 

Squamous syphilides — Differentiation from tinea circinata, psoriasis, 
lichen rubor planus, eczema, molluscum contagiosum, arsenical keratosis, 
tyloma, and venereal papillomata. 



viii Table of Contents. 

Tubercular syphilides — Differentiation from large papular syphilide, 
palmar psoriasis, palmar eczema, lupus vulgaris, acne rosacea, epithelioma, 
and tubercular leprosy. 

Tubercular syphilide and lupus vulgaris — Differential diagnosis. 

Pustular syphilide — Differentiation from smallpox, acne vulgaris, acne 
varioliformis (Hebra), acne necrotica (C. Boeck), and acne cacbectioorum 
— Pemphigus serpiginoaus. 

Yaws. 

SYPHILITIC AFFECTIONS OF THE DIGESTIVE ORGANS. 

Month, including Tongne and Tonsils 65 

First Stage of Syphilis. 

Initial lesion — Lower lip — Upper lip — Tongue— Mucous membrane of 
buccal cavity — Palate — Tonsils. 

Oral chancre — Differentiation from chancre and cancer. 

Lips — Differentiation between chancre and epithelioma. 

Lingual chancre- — Differentiation from cancer — Parenchymatous glos- 
sitis — Tuberculosis and traumatic ulcer. 

Second Stage of Oral Syphilis 68 

Mucous [latches — Differentiation from trauma, patches due to cauteriza- 
tion or strong gargles, simple catarrhal angina, leucomata, aphtha, simple 
rashes, warty growths, lingua geographica, and diphtheria. 

Third Stage of Oral Syphilis 70 

Gummata — Differentiation from cancer, tuberculosis, chancre, leuco- 
plakia, and decubital glossitis. 

Tertiary syphilis of the tongue — Differentiation from indurated 
chancre, psoriasis, smoker's tongue, dental glossitis, and epithelioma. 

Syphilitic atrophy — Nodes — Gummata. 

Deep gummata of tongue — Differentiation from fatty tumors, fibroid 
tumors, carcinoma, chronic abscess, and embedded foreign body. 

Epithelioma and gumma of tongue. 

Oral chancre — Gumma — Epithelioma — Tuberculosis. 

Syphilitic fissures and ulcers of the tongue. 

The teeth — Hutchinson's description of malformation. 

Tonsils — Chancre — Angina — Mucous patches — Gummata — Gummatous 
ulcer. 

Syphilis of the Esophagus 84 

Chancre — Syphilides — Stricture — Gumma — Coincidence of carcinoma 
and gumma. 

Syphilis of the Stomach 85 

Chancre — syphilitic ulcers and neoplasms — Syphilitic gastritis — Gastric 
hemorrhage. 



Table of Contents. ix 

Differentiation between syphilis of the stomach, neoplasm, infiltration, 
ulcer, and syphilitic gastric catarrh, simple chronic gastric catarrh, simple 
gastric ulcer, cancer of the stomach, tuberculosis of the stomach, and 
gastric neuroses. 

Syphilis of the Intestine 101 

Syphilis of intestine- — Ulcer — Diarrhoea. 

Differentiation from intestinal catarrh due to anti-syphilitics, intestinal 
tuberculosis, internal cancer, simple intestinal catarrh, and simple ulcer. 

Syphilis of the Liver 104 

Hepatic congestion — Syphilitic hepatitis — Syphilitic icterus — Acute 
yellow atrophy — Hepatic gummata — Perihepatitis — Syphilitic cirrhosis — 
Amyloid degeneration — Ascites. 

Pylephlebitis — Pigment liver — Diaphragmatic pleurisy — Cancer — Tuber- 
culosis of liver — Gallstones. 

Syphilis of the Pancreas 115 

Hereditary syphilis — Pancreatis. 
Acquired syphilis — Pancreatis — Gumma. 

Syphilis of the Peritoneum 116 

Peritonitis — Local — General. 

Syphilis of the Rectum and Anns 116 

Chancre — Syphilides — Gumma — Stricture. 

Differentiation from cancer, rectal tuberculosis, fistulae, rectal abscess, 
hemorrhoids, prolapse, polypi, pruritus, ulcer, fissure, simple stricture, 
rodent ulcer, fecal impaction, villous tumor, neuralgia, sacrococcygeal 
arthralgia, and proctitis. 

SYPHILITIC AFFECTIONS OF THE RESPIRATORY ORGANS. 

Syphilis of the Nose 125 

Chancre — Syphilides — Mucous patches — Catarrh — Gumma — Coryza — ■ 
Ozena — Sinking of nasal bridge — Destruction of tissue and contraction of 
cicatricial tissue — Deformity. 

Ozena syphilitica — Rhinitis syphilitica necrotica — Punaise. 

Differential diagnosis — Tuberculosis — Lupus — Rhinoscleroma — Carci- 
noma — Simple atrophic rhinitis — Glanders — Leprosy — Bacillus mallei — 
Bacillus leprae — Spirochete pallida — mallein test — Wasserman reaction. 

Differentiation of acute syphilitic rhinitis from common colds, toxic 
rhinitis, rhinitis of the acute infections, membranous rhinitis, hay fever, 
occupation rhinitis, phlegmonous rhinitis, acute edematous rhinitis, and 
simple ulcerative rhinits. 

Syphilitic chronic rhinitis — Differentiation from tuberculosis, glanders, 
leprosy, actinomycosis, rhinoscleroma, cancer, simmple chronic rhinitis, 



x Table of Contents. 

intumescent rhinitis, hyperplastic rhinitis, simple ozena, atrophic rhinitis, 
purulent rhinitis, nasal hydrorrhcea, and edematous rhinitis. 

Syphilitic nasal ulcer — Differentiation from simple catarrhal erosions, 
herpetic ulcerations, eczema, ulcer due to foreign bodies, neuropathic ulcers, 
scurvy, diabetic ulcers, varicose ulcers, cancer, tuberculosis, leprosy, glan- 
ders, diphtheria, measles, rheumatism, scarlet fever, smallpox, typhoid 
fever, typhus. 

Syphilitic affection of the accessory sinuses — Chronic purulent 
ethmoiditis — Empyema of sphenoidal sinus — Gummata. 

Syphilitic snuffles. 

Syphilis of the Nasopharynx 146 

Chancre — Syphilides — Mucous patches — Syphilitic adenoids — Cervical 
glands — Gummata — Necrosis— Infiltration of velum — Syphilitic catarrh — 
Ulceration — Deformity — Affection Of sphenoid bone — Scar tissue. 

Differentiation from tuberculosis of the nasopharynx, lupus, cancer, 
gangrenous ulceration, simple tumors, polypi, glanders, actinomycosis, 
simple nasopharyngitis, atrophic nasopharyngitis, hyperplastic naso- 
pharyngitis, and affection of the nasopharynx in the infections. 

Syphilis of the Larynx 149 

Chancre — Erythema — Mucous patch — Syphilitic ulcer — Gumma — 
Stenosis. 

Syphilitic laryngitis — Differentiation from simple acute laryngitis, 
laryngitis of the infections, rheumatic laryngitis, simple acute epiglottitis, 
traumatic laryngitis, suppurative laryngitis, edema of the larynx, mem- 
branous laryngitis, hemorrhagic laryngitis, simple chronic laryngitis, 
follicular laryngitis, atrophic laryngitis, hyperplastic laryngitis, simple 
hyperemia of the larynx, pemphigus of the larynx, tuberculosis of the 
larynx, and chondritis and perichondritis. 

Laryngeal ulcers — Gumma, tuberculosis, carcinoma. 

Laryngeal growths — Syphilomata — Differentiation from carcinoma, 
sarcoma, papilloma, adenoma, fibroma, chondroma, anginoma, lipoma, 
mucocele, and tuberculosis. 

Stenosis of the larynx — Syphilis — Cancer — Tuberculosis — Lupus — 
Trauma — Congenital — Occlusion. 

Syphilis of the Trachea 169 

Syphilides — Gummata — Ulceration — Perichondritis and necrosis— De- 
formity — Perforation — Stenosis. 

Differentiation from tuberculosis, scleroma, cancer, glanders, and 
chronic non-syphilitic blenorrhoea. 

Syphilis of the Bronchi 170 

Early bronchitis in the second stage of syphilis — Second and third 
stages of syphilis — Syphilitic bronchial stenosis. 

Syphilitic Affections of the Lungs 171 



Table of Contents. xi 

Syphilitic pulmonary catarrh — Cough — Hemoptysis — Cachexia — Second- 
ary infection with influenza, tuberculosis, pneumonia. 

Differential diagnosis between pulmonary syphilis and pulmonary 
tuberculosis. 

Pleurisy — During second stage — During third stage! — Gummata. 

SYPHILITIC AFFECTIONS OF THE CIRCULATORY ORGANS. 

The Heart 174 

Affection during second stage — Palpitation — 'Cardiac asthma. 

Affection during third stage — Gummata — Scleroses — Sudden death — 
Precordial anxiety — Myocarditis — Frequency of aortic lesions. 

Wassermann reaction. 

Syphilitic myocarditis — Differentiation from simple myocarditis. 

Syphilitic pericarditis — Differentiation from simple pericarditis, and 
from endocarditis, pleurisy, hypertrophy of the heart, mediastinal tumors 
and irritation or inflammation of the stomach. 

Syphilitic endocarditis — Differentiation from endocarditis due to other 
causes. 

The Blood Vessels 179 

Syphilitic arteries — Arteriosclerosis — Aneurysm — Endartitis obliter- 
ans — Thrombosus — Rupture. 
Syphilitic phlebitis. 

The Blood 179 

"Blood disease" — Spirochete pallida — Wassermann reaction — Syphilitic 
anemia — Chlorosis — Leucocytosis — Pernicious anemia — Non-syphilitic 
anemia in syphilitics. 

Cachexia 180 

Syphilitic cachexia — Differentiation from cachexia due to malaria, 
syphilis, chronic sepsis, phthisis, lead poisoning, cancer, and infantile scurvy. 

Amyloid 180 

Amyloid due to hereditary syphilis — Acquired syphilis — Tuberculosis. 
Affection of the blood vessels — Arteries and veins — Spleen, liver, 
kidneys, intestines. 

SYPHILITIC AFFECTIONS OF THE GLANDS. 

Lymphatic Glands 182 

First stage — Order of involvement — Indolent buboes — Differentiation 
from the adenopathies of tubercle, cancer, chancroid, gonorrhoea, eczema, 
prurigo, and simple infected sores. 

Second stage — Regions involved. 

Scrofula — due to syphilis, tuberculosis, rarely due to leprosy, glanders. 



xii Table of Contents. 

Third stage — Gummata and syphilitic scars — Adenopathies due to 
infected gumma. 

Gummata of the lymphatics. 

Differential diagnosis — Buboes due to syphilis, inflammatory tuber- 
culosis, tuberculosis, cancer, leprosy, glanders. 

Syphilitic and inflammatory lymphangitis. 

Spleen 192 

Syphilis — Malaria — Tuberculosis. 

Hereditary syphilis — Soft and indurated hyperplastic enlargements — 
Amyloid change. 

Acquired syphilis — First stage — Non-luetic enlargements — Second 
stage — Third stage — Gummata. 

Thymus Gland 192 

Hyperplasia — Induration. 
Bibliography. 

Thyroid Gland 193 

Syphilitic goitre — Non-luetic goitre — Gummata. 
Bibliography. 

Suprarenal Bodies 195 

Gummata — Addison's disease. 
Wassermann reaction — Therapeutic test. 

Syphilis of the Breast 195 

first stage — Chancre — Fissure — Multiple chancres — Due to nursing 
syphilitic child — Other causes — Chancroid. 

Second stage — Mucous patches — Infectious secretions — Lesion in the 
obese — Resemblance to chancroid — Pigmentary syphilide. 

Third stage — Gummata, circumscribed or diffuse — Indolence — Adeno- 
pathy — Slow growth — Disintegration — Ulceration — Deformity — Resem- 
blance to cancer. 

Wassermann reaction — Therapeutic test. 

SYPHILITIC AFFECTIONS OF THE URINARY ORGANS. 

Kidneys 197 

Acute nephritis — Subacute nephritis — Chronic nephritis — Granular 
Kidney — Gummatous infiltration — Amyloid kidney — Perinephritis and para- 
nephritis — Hematuria — Hemoglobinuria. 

Ureter 198 

Gumma — Dilatation — Obstruction. 

Bladder 198 

Ulcers — Cystoscopic examination. 



Table of Contents. xiii 

Syphilis of the Urethra 199 

Chancre — Differentiation from gonorrhoea, chancroid, and simple 
stricture. 

Second stage — Syphilides — Endoscopic examination — Papular syphi- 
lides — Erosions — Urethral herpes. 

Third stage — Gummata — Ulcers — Cicatrices — Differentiation from 
cancer and tuberculosis of the urethra. 

Differential diagnosis— Urethral chancre, gonorrhoea, chancroid, and 
stricture. 

Differential diagnosis — Urethral syphilides, herpes. 

Differential diagnosis — Urethral gumma, tuberculosis and cancer. 

THE MALE GENERATIVE ORGANS. 

Syphilis of the Penis 205 

Chancre — Roseola — Papular syphilides — Gumma — Scars. 

Subpreputial ulceration in phimosis — Differentiation between chancre 

and non-syphilitic ulceration. 

The Testicles 215 

Differential diagnosis — Syphilitic orchitis, traumatic orchitis, gonor- 
rhceal orchitis, epidemic orchitis, tuberculosis, and cancer. 

The Semen 225 

Aspermda — Paternal transmission of syphilis — Syphilitic impotence 
and fertility. 

SYPHILITIC AFFECTIONS OF THE FEMALE GENERATIVE 
ORGANS. 

Syphilis of the Vnlva 226 

Chancre — Differentiation from simple ulcer, chancroid, cancer, tuber- 
culosis and lupus. 

Syphilides — Mucous patches. 
Third stage — Gumma. 

Syphilis of the Vagina 232 

Chancre — Syphilides — Gummata — Fistula?. 

Uterus 232 

Chancre — Location — Rubber gloves — Manner of infection — Differentia- 
tion from cancer, chancroid, tuberculosis, simple ulcers, and gonorrhoea. 
Second stage — Syphilides — Papules — Endometritis. 
Third stage — Gummata. 

Fallopian Tabes 233 



xiv Table of Contents. 

Primary sore — Catarrhal salpingitis in second stage — Gummata in third 
stage. 
The Ovaries 233 

Third stage — Gummatous oophoritis — Cicatrices — Tumors. 

SYPHILITIC AFFECTIONS OF THE ORGANS OF 
LOCOMOTION. 

Periosteum 234 

Simple periostitis — Periostitis syphiliticus ossificans — Absorption — Dis- 
integration — Wassermann reaction — Spirochete pallida — Myositis ossificans 
— Suppurative periositis — "Cold" abscesses — Tuberculosis. 

Gummatous periosititis — Sclerosis and hyperostosis — Erosion of bone — 
Perforation — Absorption — Ulceration — Caries and necrosis — Fistulse— Gum- 
matous Nodules. 

Bones 237 

Simple syphilitic ostitis — Syphilitic osteomyelitis. 

Gummata — Osteoporosis — Sclerosis — Absorption— Caseation — Sequestra 
— Necrosis — Gummatous infiltrations. 

Syphilitic cachexia — Fragilitis ossium. 

Tumor — Fragility — Shortening and destruction of bone. 

The skull — Frontal bone — Parietal bones — Bones of nose and hard 
palate — Meningitis — Syphilitic tumors— Pressure symptoms — Mental dis- 
turbance — Orbital bones — Syphilis of the base of the skull — Facial bones — 
Nose and upper jaw. 

Spinal column — Cervical spine — Vertebral arches — Transverse proc- 
esses — Vertebral artery — Kyphosis. 

Syphilis of the long bones — Legs — Forearm — Ribs — Diaphysis — Toint 
affection — Trauma — Analogy to tuberculosis — Enlargement of bone — Noc- 
turnal pain. 

Small bones — Dactylitis syphilitica — Differentiation from paronychia, 
whitlow, gout, rheumatoid arthritis, enchondroma, tubercular dactylitis — 
Drumstick fingers — Toes — Ulcus pedans. 

Differentiation of syphilis from trauma, tuberculosis, sarcoma, rickets, 
osteomalacia, mercurial necrosis, phosphorus necrosis, actinomycosis, 
necrosis disseminata (Blasius). 

Differentiation between syphilitic osteitis and tubercular osteitis. 

Differentiation — Syphilis — Rickets. 

Osteoperiostitis — Differentiation between syphilitic and non-syphilitic. 

Joints 247 

Preference of knee and elbow — Arthralgias during second stage of 
syphilis — Later arthralgias — Gummata — Chronicity — Spontaneous involu- 
tion. 

Pain — Swelling — Tenderness — Fever — Deformity of joint — Ankylosis — 
Ostitis and periostitis. 

Differentiation from joint tuberculosis, trauma, rheumatism. 



Table of Contents. xv 

Muscles 251 

Second stage — Rheumatic pains — Myositis. 

Third stage — Gumma — Infiltration — Absorption — Extension of process 
— Sinous ulcer— Impairment of function — Adhesions — Interstitial infiltra- 
tion — Scar tissue — Syphilitic myositis ossificans — Atrophy of muscles. 

Differentiation from neoplasms, sarcoma — Actinomycosis — Trichinosis 
— Muscular rheumatism. 

Tendons 252 

Gummata of muscles — Syphilitic affections of tendon sheaths — Hygro- 
mata — Syphilitic synovitis. 

Bursae 253 

Hygromata — Gummatous bursitis. 

Fasciae 253 

Nodular infiltration — Gummata of fasciae and muscles. 

SYPHILITIC AFFECTIONS OF THE NERVOUS SYSTEM. 

Brain and Cephalic Meninges 254 

Second stage — Irritation of brain and meninges — Headache — Vertigo — 
General irritability — Nausea — Fever — Acceleration of pulse — Bands of pain 
— Irregularity of pupils — Irritation of choroid and retina — Spirochete pal- 
lida in blood and cerebrospinal fluid— Wassermann reaction. 

Third stage — Meningitis — Pachymeningitis — Pachymeningitis hemor- 
rhagica — Hydrocephalus internus — Syphilitic endarteritis — Softening of 
brain — Hemorrhages — Cerebral aneurysm. 

Gummata — Dura mater — Pia Mater — Adhesions — Infiltration — Menin- 
gitis gummosa basilaris diffusa — Cerebral nerves — Gummata of brain — 
Endarteritis obliterans. 

Ophthalmoplegia — Immobility of pupils — Atrophy of optic nerve — De- 
mentia paralytica — Locomotor ataxia. 

Headache — The pulse — Choked disk — Functional and focal symptoms — 
Basilar symptoms — Affection of cerebral nerves — Oscillating hemianopsis 
bitemporalis — Affection of cerebral peduncles — Crossed paralysis — Hemi- 
plegia alternans superior — Hemiplegia alternans inferior — Affection of the 
pons — Facial nerve — Disturbance of speech and deglutition — Acute bulbar 
paralysis — Affection of corpora quadrigemina — Oculomotors — Disturbances 
of equilibrium and coordination — Cerebellum — Medulla oblongata. 

Deeper portions of brain — Gumma — Softening — Hemorrhage — Affections 
in the region of the central ganglia. 

Syphilitic affection of the cerebral vessels — Endarteritis obliterans — 
Thrombosis — Sacculated and dissecting aneurysms. 

Cerebral symptoms — Headache — Vertigo — Insomnia — Mental irritabil- 
ity — Paresthesias, formication — Hemiplegia — Hemiparesis — Hemianesthesia 



xvi Table of Contents. 

Aphasia — Hemianopsia — Vacillating cerebral symptoms — Multiple lesions 
in syphilis of brain — Circumscribed and diffuse gummata — Syphilitic ar- 
teritis — Syphilitic basilar meningitis, extension of process to spinal 
meninges — The psychoses — Epilepsy and hysteria. 

Mental exertion — Worry — Excessive worship of Bacchus and Venus. 

The Spinal Cord and Meninges 261 

Second stage — Spinal meningeal irritation — Pain and paresthesia? — 
Skin and tendon reflexes. 

Third stage — Gummata — Syphilitic vertebral periostitis — Spinal 
meninges — Spinal nerves — Blood vessels — Early symptoms of spinal syph- 
ilis — Location of affection of cord and various spinal tracts — Meningomye- 
litis syphilitica — Acute, subacute and chronic myelitis — Pseudo tubes syph- 
ilitica — Multiple sclerosis — Syphilitic progressive muscular atrophy — 
Syphilitic spinal paralysis of Erb — Spasmodic tabes dorsalis of Charcot — 
Tabes dorsalis — Wassermann reaction. 

Peripheral Nerves 265 

Affection in cerebral and spinal syphilis, gummatous infiltrations of 
bones, periosteum, muscle and fascia. 

Neuralgia due to meningeal irritation — Peripheral neuralgia — Trigem- 
inal neuralgia — Neuralgias of spinal nerves — Neuralgia of occipitalis 
major — Nervus auricularis magnus — Neuralgia of brachial plexus — Inter- 
costal neuralgia — Sciatica — Visceral neuralgias. 

Paralysis due to brain and spinal syphilis — Syphilitic peripheral 
paralysis — Cranial nerves — Oculomotor paralysis — Facial paralysis, uni- 
lateral and bilateral — Auditory — Abducens — Trigeminus — Hypoglossal. 

SYPHILITIC AFFECTIONS OF THE ORGANS OF SPECIAL 
SENSE. 

Organs of Sight 274 

Deep-seated affections of sight — Cerebral diseases — Affections of the 
optic nerve. 

The eye — Eyebrows — Initial lesion. 

Lids — Initial sclerosis — Papules — Ulceration conjunctiva — Preauricular 
and submaxillary lymphatic glands. 

Second stage — Lids — Macules — Papules — Pustules — Ulcers — Madarosis 
— Alopecia. 

Third stage — Gummatous infiltrations and ulcerations of lids — Hor- 
deola — Chalazion — Superficial flat infiltrations — Tumors — Tarsitis syphilit- 
ica deformity. 

Differentiation from nonsyphilitic hordeolum and chalazion — Lupus — 
Cancerous ulcer. 

Syphilitic blepharitis — Differentiation from blepharitis due to tuber- 
culosis, the exanthemata, anemia and malnutrition, external irritation, 
injuries, conjunctivitis, inflammation of lachrymal passages, disease of the 
rhinopharynx, eczema, eczema seborrhoticum, seborrhcea, or acne. 



Table of Contents. xvii 

Syphilitic dacryoadenitis — Differentiation from "colds" — Traumatism — 
Rheumatism — Mumps — Gout — Septicemia, and extension of inflammations 
from conjunctiva and cornea. 

Dacryocystitis. 

Conjunctiva — Chancre — Papular syphilides — Pigmented spots — Mucous 
patches — Nodular syphilides — Syphilitic ulcer — Gummata. 

Stricture of the nasal duct. 

Cornea — Keratitis parenchymatosa — Association with affections of 
ear and teeth. 

Iris — Syphilitic iritis — Syphilitic iritis papulosa — Extension to ciliary 
bodies and choroid — Gummata. 

Ciliary body — Iridocyclitis — Iridochoroiditis — Gummata. 

Choroid — Diffuse exudative choroiditis — Choroiditis centralis — Cloudi- 
ness of crystalline lens. 

Cornea — Keraltitis parenchymatosa syphilitica — Keraltitis parenchy- 
matosa tuberculosa — Extension of gummatous infiltration from conjunctiva 
or sclera. 

Sclera — Gummata— Differentiation from malignant neoplasms. 

Iritis — Local and general causes. 

Retina — Hyperemia and irritation in syphilis — Early hyperemia of 
optic nerve — Affection of retinal blood vessels — Amblyopia and amaurosis — 
Primary syphilitic retinitis— Syphilitic chorioretinitis — Retinitis pro- 
liferans. 

Crystalline lens — Cloudiness — Hyalitis syphilitica — Gummata. 

Gummata of the orbit. 

Opacities of the vitreous. 

Optic nerve — Intrabulbar optic neuritis — Retrobulbar neuritis — Choked 
disk — Simple optic neuritis. 

Causes of choked disk. 

Causes of optic neuritis. 

Retrobulbar neuritis — Acute or fulminant retrobulbar neuritis — 
Chronic retrobulbar neuritis — Differentiation between syphilitic and toxic 
retrobulbar neuritis. 

Causes of atrophy of the optic nerve. 

Affections of the ocular muscles — Syphilitic paresis — Muscular spasm 
— Innervational anomalies — Non-syphilitic causes of paresis and spasm. 

Organs of Hearing 287 

Central changes. 

Ear — Chancre. 

Second stage — Muscles, papules, and pustules — Auditory canal — Drum 
membrane — Ulcerations — Cicatrices. 

Third stage — Gummata — Ulcerations — Infiltrations — Cicatricial con- 
tractions and deformities. 

The middle ear — Syphilides — Gummata — Occlusion of Eustachian tube 
— Deafness — Otitis media — Labyrinth — Caries and necrosis of tympanic 
cavity, mastoid, petrous portion of temporal bone. 



xviii Table of Contents. 

The internal ear — Auditory nerve — Labyrinth — Deafness — Vertigo — 
Disturbances of equilibrium. 

Disturbances of hearing and hallucinations in basilar meningitis. 

Organs of Smell 289 

Alterations of sense of smell — Central disease — Basilar meningitis — 
Rhinitis syphilitica. 

Organs of taste 290 

Central disturbances — Syphilis of tongue and palate — Syphilitic in- 
volvement of glossopharyngeal or fibres of chorda — Trigeminal neuralgia. 

Conclusions 29 1 

Bibliography 292 



Diagnosis of Syphilis 



Pox; Lues Venerea. 



The diagnosis of syphilis is usually easy, but at times 
may be very difficult. No disease shows a greater variety 
of symptoms, and there are few diseases but may resemble 
this multiform affection. 

Syphilis is a chronic infectious disease, due to the 
Spirochaete pallida. The disease may be transmitted through 
heredity (congenital syphilis), or through inoculation (ac- 
quired syphilis). 

BACTERIOLOGY. 

Microorganisms have been described in syphilis by nu- 
merous observers. In 1839 Donne described organisms that 
he compared to vibrios, which Metchnikoff believes corre- 
spond to the organism described by Schaudinn as the Spir- 
ochaete refrigerans. Later Donne became convinced that 
this was not the cause of syphilis. Microorganisms in syph- 
ilitic lesions have been described by Lustgarten (1884), 
Eve and Lingard, (1886), Disse and Taguchi (1886), Gol- 
asz (1894), Max von Niessen (1898), and by Fritz Schau- 
dinn and Erich Hoffmann, in May, 1905. 

The organism described by the last named observers, 
the Spirochaete pallida, is of paramount importance from 
a diagnostic standpoint, since it is the specific cause of 
syphilis. Other microorganisms are of importance, inso- 
much as they may operate as secondary infections. 



2 Diagnosis op Syphilis. 

For a long time the Lustgarten bacillus was regarded 
by many as the specific cause of syphilis. Possibly color 
was given this belief by the cuts that appeared in medical 
literature, for when the Lustgarten bacillus is colored red, 
it looks much like the tubercle bacillus. And the simi- 
larity of man}' of the lesions of syphilis and tuberculosis 
may have been a factor in furthering the belief that the 
Lustgarten bacillus was the cause of sypliilis. But the 
Lustgarten bacillus resembles the tubercle bacillus more in 
the cuts than in bacteriological characteristics, such as cultural 
and staining properties. It resembles, if it is not identical 
with the smegma bacillus. 

Some general knowledge of the nature and size of the 
syphilitic virus preceded the discovery of the spirochete pal- 
lida. Thus, by passing the virus through filters, it had 
been determined that the syphilitic virus was larger than 
those microorganisms that pass through a filter, such as 
the bacillus of broncho-pneumonia of cattle. Furthermore, 
it was known that the virus could he destroyed by heating 
to 60° C. for half an hour. 

It is remarkable how soon Schaudinn's discovery* was 
accepted by the medical profession. 

Schaudinn was a zoologist, a member of the Imperial Coun- 
cil of Health, and Hoffmann a retired army medical offi- 
cer. Both were known as experts in the study of protozoa 
and spirochetes. Though Schaudinn lived only about a 
year after announcing his discovery, he lived long enough 
to see his work receive general recognition. 

The Spirochete Pallida. 

The Spirochaete pallida, triponema pallidum, measures 
from four to twenty microns long, and 0.25-0.50 micron in 
diameter. The average length is about that of the diameter 



*(Ueber Spirochaeten-Befunde im Lymphdriisensaft Syphilitiscker, 
F. Schaudinn and E. Hoffmann, Deutsche medizinische Wochenschrift, xxxi, 
No. 18.) 



Diagnosis op Syphilis. 3 

of a red-blood corpuscle. The organism presents the ap- 
pearance of a very delicate spiral, a corkscrew, with from 
four to as many as twenty-six coils, and pointed extremi- 
ties. Goldhorn reported observing one that presented forty 
turns. Reports of such extreme lengths should be received 
with caution, since several organisms may be so coiled to- 
gether as to present the appearance of a single long spiril- 
lum with more than the usual number of turns. 

At times the line separating the bacteria and the pro- 
tozoa seems undulating rather than rigid. At any rate, 
in some respects the spirochete pallida resembles the bac- 
teria, e. g., in its analogy to the spirillum Obermeieri of 
relapsing fever, in the absence of an undulating membrane, 
the evidence of transverse division, and the failure to find 
an intermediate host. Formerly the organism was regarded 
as a protozoon, such a view being favored by the failures 
at cultivation, the resemblance to the trypanosomes, the 
presence of flagelke, and possibly longitudinal division. In 
an attempt to properly classify this organism, the recogni- 
tion of a new genus has been proposed. Such a necessity 
is suggested by the term triponema pallidum, proposed by 
Schaudinn and Veuillemin. 

The spirochete pallida may be found in smears or 
hanging drop preparations. For such an examination, the 
surface secretions and accumulations should be removed, 
since they contain so many saprophitic spirochetes, that 
would make the examination for the delicate spirochete 
pallida more difficult. 

The spirochete pallida may be readily recognized in 
fresh specimens examined microscopically with dark-ground 
illumination. Characteristic points are found in the size, 
shape, position of ends, and the motility of the organism. 
In fresh specimens, the windings of the spiral are very 
acute and regular. The spirochete pallida is pale, as indicated 
by its name, and the ends are sharp, and placed at the periph- 
ery of the spiral, rather than in the center, as is observed 
in some spirochetes. When the specimen is fresh, the 



— 



4 Diagnosis of Syphilis. 

spirochete pallida is motile, showing rotation, rapid bend- 
ing and twisting, and also progression. The last named mo- 
tion is slower than that shown by some other spirochetes. 

When accuracy is desired, it is better to examine the 
specimen both fresh and stained. 

The Giemsa modification of the Romanowsky stain was 
the method first used by Schaudinn and Hoffmann. It is 
as follows : 

Giemsa's eosin solution, 2.5 cc. of 1% 

solution to 500 cc. distilled water. . . 12 parts 

Azur I, 1:1000 solution in water 3 parts 

Azur II, 0.8:1000 solution in water. . . 3 parts 

Method. — Thin smears are fixed in methyl or ethyl alco- 
hol for ten minutes and dried. The specimen is then stained 
for from one to twenty-four hours with a mixture of the 
stain, one drop to 1.0 cc. of water. Wash gently and 
mount. This stains the spirochete pallida a sort of pinkish 
color. The spirochete refrigerans is stained a deep blue. 
The tissue cells appear only slightly stained, the red cells 
being greenish and the white cells purplish. 

This method is not ideal. In the first place, it stains 
the spirochete pallida only faintly, so that their recogni- 
tion remains difficult. Secondly, it requires such a long 
time. This may be remedied by the addition of from one to 
ten drops of a 1 :1000 aqueous solution of potassium car- 
bonate to the water with which the stain is diluted, when 
the specimens may be stained in fifteen minutes. 

The Giemsa stain requires sixteen hours or more, and 
for that reason Metchnihoff* recommends the Marino technic, 
when more rapid results are desired. This consists in mixing a 
methyl alcohol solution of azure blue with a weak aqueous 
solution of eosin. This is not so distinct as the Giemsa 



*(Recherches microbiologiquessur la syphilis, E. Metchnikoff and E. 
Rous, Bulletin de l'AcadSmie, lxix, Ko. 26.) 



Diagnosis of Syphilis. 5 

stain, but by this means a diagnosis can be made in fifteen 
minutes. 

A deeper stain is secured by Proca's stain, recommended 
by Ewing. It is as follows: 

Fix the specimen, in alcohol for thirty seconds, or in 
the vapor of 1% osmic acid for two to five seconds. Apply 
the mordant (a) for ten minutes. Wash. Stain with the 
gentian violet solution (b) for five minutes. Wash, dry 
and mount. 

(a) The mordant is prepared as follows: 

Carbolic acid 50 parts 

Tannin 40 parts 

Distilled water 100 parts 

Basic fuchsin, 25 parts dissolved in 100 of absolute 
alcohol. 

(b) The gentian violet solution is prepared as follows: 
Gentian violet, concentrated solution in 

alcohol 10 parts 

Carbolic acid 5 parts 

Distilled water 100 parts 

One of the best stains is that proposed by Goldhorn, 
which is prepared as follows: 

Lithium carbonate 2 grams 

Dissolve in distilled water 200 cc. 

Methylene blue 2 grams 

Heat in a double boiler over a slow fire, until a specimen 
examined against artificial light appears distinctly red in 
color. Allow to cool and then strain through cotton. Ren- 
der one-half of the solution slightly acid with 5% acetic 
acid solution, and then add the other half of the stain, 
which will secure a slight alkalinity. Add a weak eosin so- 
lution (0.5%) gradually while stirring, until a filtered spec- 
imen of the stain is of a pale bluish color with slight fluor- 



6 Diagnosis of Syphilis. 

escence. Set aside for a day and then filter. The precipi- 
tate is permitted to dry on the filter paper at a temperature 
not exceeding 40° C. Dissolve the dry precipitate in wood 
alcohol, set aside for a day and filter. The quantity of 
alcohol used should make about a 1% solution. 

Method. — The Goldhorn stain gives better results when 
fresh. Without fixing, the smear is covered with the stain 
for four or five seconds. Carefully pour the stain off and 
place the specimen in clean water at room temperature for 
three or four seconds. Dry in the air. The spirochete 
pallida will present a violet color, which may be changed 
to bluish black by staining with gram solution for fif- 
teen or twenty seconds. 

The May Grunwald stain : 

Eosin 1.0 gm. and methylene blue 1.0 gm. are dissolved 
separately in 1000.0 cc. of distilled water for each stain. 
The two solutions are then mixed and let stand from two 
to seven daj's. The fluid is filtered and the sediment on 
the filter is washed until no more color comes away. It 
is then dried and dissolved in pure methyl alcohol to satura- 
tion. 

Method. — A few drops are placed on the specimen for 
from four to ten seconds, after which the specimen is rinsed, 
dried and mounted in balsam. 

This stain is highly recommended by Simonelli and 
Bandi.* The spirochetes are stained, the remainder of the 
specimen being almost colorless. 



*(Metodo rapido di colorazione della Spiroeha;te pallida, F. Simonelli, 
Gazzetta degli Ospedali, xxvi, No. 82.) 



Diagnosis of Syphilis. 7 

The GJioreyer Osmic Acid Stain: * 

Solutions. — 1% aqueous solution of osmic acid. 

Liquor plumbi subacetatis, diluted 100 times with distilled 
water. The diluted solution should be fresh. 

10% aqueous solution of sodium sulphide. 

Method. — Thin smear. No heat fixation is necessary. 
Cover with osmic acid solution for thirty seconds. Wash in 
running water. Cover with subacetate solution for ten sec- 
onds. Wash in running water. Cover with sodium sulphide 
solution for ten seconds. Wash in running water. Repeat 
this process three times. Apply osmic acid solution for thirty 
seconds. Wash in running water. Dry and mount in balsam. 

The osmic acid acts as a fixative. The lead unites with 
the albumin to form lead albuminate, which is insoluable in 
water. Sodium sulphid transforms the lead albuminate into 
lead sulphid, and stains the specimen brown. Osmic acid turns 
the brown color to black. Spirochetes, bacteria and cellular 
detritus are black. 

Tissue Sections. 

A good method of staining the spirochete pallida in 
sections, is that used by Livaditi: 

Sections 1.0 mm. thick are fixed in 10% formalin for 
twenty-four hours. Wash and harden in alcohol for twelve 
to sixteen hours. Wash in distilled water until the section 
sinks. Place at room temperature for two or three hours 
in a 1% solution of nitrate of silver in distilled water to 
which 10% of pyridin is added just before using. Wash 
rapidly in 10% of pyridin. Place for several hours in a 
4% solution of pyrogallic acid in distilled water, containing 
15% pyridin, with the addition of 10% acetone just before 
using. Harden in alcohol. Clear in xylol and mount in 
paraffin. 



*A new and quick method for staining spirochetes (treponemata in 
smear preparations. Albert A. W. Ghoreyer, Jour. A. M. A., liv, 1498, 
May 7, 1910. 



Diagnosis of Syphilis. 



Spirochetes in the Blood. 

Richards and Hunt* found the spirochete pallida in the 
blood in the second stage of syphilis, drawing the blood from a 
typical spot a few days after the appearance of the eruption. 
The skin was cleaned with soap and then with spirit, and the 
blood was received upon clean slides. The films were stained 
with Giemsa's stain one part in three parts of distilled water. 
Other cases were examined, and the blood was drawn from 
the spots on the abdomen, chest and arm. In these cases 
the spirochete had been previously found in the primary lesion. 
In some cases, a prolonged search is necessary, since the 
spirochetes do not occur in large numbers. 

Acetic acid may be added before the stain, t 
1.0 cc. of blood is dissolved in 10.0 cc. of 0.3 per cent, 
acetic acid, and then centrifugized and the Giemsa stain ap- 
plied. The acetic acid does not interfere with the action 
of the stain, though the specimens be left in it for several 
hours. 



Flagella. 

Schaudinn J demonstrated flagella in the spirochete pallida. 
For this purpose he found the old Loeffler bacterial flagellum 
stain best. The spirillum pallida is the only one in which he 
found flagella at one or both ends. Some spirochetes show 
an undulating membrane, but he was unable to find this in 
the spirochete pallida. 



*(The occurrence of a spirillum in the blood of patients suffering 
from secondary svphilis. G. M. O. Richards and L. Hunt, Lancet, Septem- 
ber 30, 1905.) 

t(Zur Nachweis der Spirochete pallida im Blut Syphilitischer, C. T. 
Noeggerate and R. Staehelin, Munchener medizinische Wochenschrift, Hi, 
No. 31.) 

t(Zur Kenntnis der Spirochete pallida, F. Schaudinn, Deutsche 
medizinische Wochenschrift, xxxi, No. 42.) 



Diagnosis op Syphilis. 



THE SERUM DIAGNOSIS OF SYPHILIS. 

The serum reaction in syphilis is of very great diag- 
nostic value. But it is not so absolute as is the finding of 
the spirochete pallida. They may be compared to the blood 
test in typhoid fever and the finding of the tubercle bacillus 
in tuberculosis. The one is of relative diagnostic value; the 
other makes the diagnosis absolute. 

It is well known that when blood from another animal, 
so-called alien blood, is injected into an animal, the blood 
serum acquires properties that enable it to destroy the blood 
corpuscles of the animal from which the alien blood was 
obtained. The mixture becomes blood-stained, through the 
destruction of the corpuscles and the solution of the liber- 
ated haemoglobin. 

Complement is normally present in serum, and is de- 
stroyed by heating to 55° C. for half an hour. The immune 
body or amboceptor, which is present in the serum of the 
immunized animal, is not destroyed by heating to 55° C. for 
half an hour. Therefore, we may obtain the immune body free 
from complement by heating to 55° C. for half an hour, and 
the complement may be replaced at will by the addition of 
normal unheated serum. For example : If red-blood cor- 
puscles of the ox be injected into a rabbit, in a few days 
the blood serum of the rabbit will have the power of dissolv- 
ing the ox corpuscles, a process called haemolysis. But the 
immune rabbit serum, if heated to 55° C. (destroying the 
complement and leaving only the immune body), would not 
dissolve the ox corpuscles, unless normal rabbit serum (con- 
taining complement) be added, when haemolysis occurs. 

The body cells, in adaptation to alien substance of pro- 
toplasmic origin, elaborate antitoxins, antiferments, agglu- 
tinins, precipitins, and cytolysins (hemolysins, bacteriolysins, 
and special cytotoxins, such as spermatoxin, nephrotoxin, 
hepatoxin, etc.), which are formed of two substances: (1) 
complement, known also as alexin, addiment and cytase; and, 



10 Diagnosis of Syphilis. 

(2) amboceptor, variously known as immune body, inter- 
mediary body, substance sensibilisatrice, Fixateur, Praepera- 
teur, copula, and desmon. 

If the alien protoplasmic substance (antigen) be mixed 
with serum containing its antibody, and complement added, 
the complement will disappear and there will be no haemoly- 
sis. This is known as complement deviation, and is the line 
along which Wassermann was working when he elaborated 
the test for syphilis that bears his name. Thus, the Wasser- 
mann reaction consists in mixing the blood serum of the 
suspected syphilitic with a water} 7 emulsion of the liver ob- 
tained from a case of congenital syphilis, in which the spiro- 
chete pallida is present in large numbers. If complement 
deviation occur, it is regarded as evidence that the spiro- 
chete pallida in the patient's body has stimulated the for- 
mation of antibodies, which reacted with the organisms 
present in the liver emulsion. 

There are some apparent inconsistencies with the theories 
upon which the Wassermann reaction is based. Thus, a re- 
action may be obtained with an emulsion of normal liver 
or of other normal organs, such as an emulsion of normal 
guinea-pig heart, instead of the watery emulsion of syphilitic 
liver. This would seem to controvert the theory that the 
reaction depends upon an antigen containing the spirochetes. 
Further, it has been observed that an alcoholic solution 
may be used, instead of the watery solution, which would 
indicate that the substance looked upon as an antigen is 
not albuminous. It has been suggested that these sub- 
stances may be lipoids, possibly lecithin. 

We must not roam too far in the realm of theory. It 
is possible that there is a difference between the Wassermann 
reaction and the reactions obtained with normal organs and 
alcoholic solutions, used instead of the syphilitic liver in 
watery solution. It has been observed that the results ob- 
tained by the two methods are not identical. 



Diagnosis of Syphilis. 11 

Hecht* made use of the amboceptor and complement 
of human serum for sheep's blood, and employed an alcoholic 
extract of guinea-pig's heart as antigen. Modifications of 
this method have been used by a number of observers, Fleming, 
Levaditi, Sabrazes and Eckstein. Margarett declares this 
method to be superior to the original technique of Was- 
sermann. 

Antigen. — Use may be made of guinea-pig heart, rabbit 
heart, or human heart. The latter is preferred by some 
workers. The heart muscle, freed from fat, is washed free 
from blood and cut up in a mincing machine. Twenty 
grammes of the minced heart muscle is triturated in a mor- 
tar with the gradual addition of absolute alcohol to 100 cc, 
then transferred to a flask and well shaken. It is then placed 
on a water bath at 60° C. for two hours, and left at room 
temperature for twenty-four hours, then decanted. For use, 
this alcoholic extract is diluted with saline solution, the de- 
gree of dilution being determined by testing with known 
syphilitic and non-syphilitic serum, and choosing the dilu- 
tion that will prevent haemolysis with syphilitic serum but 
will have no effect on non-syphilitic serum. If kept in a 
well corked bottle and away from the light, the extract will 
remain useful for several months. The amount of dilution 
required can be determined only by testing. 

The sheep's corpuscles may be obtained twice a week. 
Five cc. of defibrinated blood is mixed with 100 cc. saline 
solution and kept in a cotton stopped flask in an ice chest. 
The flask should be shaken from time to time, to renew the 
oxygen. If haemolysis takes place, the fluid should be pipetted 
off and replaced by a fresh solution. 

For examination, 1 cc. or 2 cc. of blood is sufficient. 
Collect in small glass tubes, plug with cotton wool and keep 
in an ice chest. The serum will keep longer if separated 
from the clot. It should be examined soon, since sometimes the 



*(Eine Vereinfaehung der Kompliment-Bindung-Eeaktion bei Syphilis, 
Wiener klinische Wochenschrift, 1908, No. 50, p. 1742.) 



12 Diagnosis of Syphilis. 

serum will lose its haemolytic power at the end of two or 
three days ; again, it may remain active for ten days. 
The test. Three tubes are used. 

Tube No. 1 — 100 cubic millimeters of serum. 

100 cubic millimeters of saline solution. 
100 cubic millimeters of antigen. 

Tube No. 2 — 100 cubic millimeters of serum. 
200 cubic millimeters of antigen. 

Tube No. !3 — 100 cubic millimeters of serum. 

200 cubic millimeters of saline solution. 

The tubes are incubated at 37° C. for an hour and a 
half, then 100 cubic millimeters of sheep's corpuscles are 
added to each tube, and the specimens are returned to the 
incubator until hemolysis takes place in the control tubes, 
usually from ten to thirty minutes. Place in an ice chest 
until sedimentation of the non-hsmolysed corpuscles takes 
place. 

Positive Result. — No haemolysis is in the first and second 
tube, but haemolysis in the third tube. Negative. — Haemolysis 
in all three tubes. A trace of haemolysis in the first tube, 
if the second remains clear, indicates a positive result. Com- 
plete haemolysis in the first tube and no haemolysis in the 
second, indicates a negative result. 

Cerebrospinal Fluid. 

Employ a unit of 150 cubic millimeters, instead of 100. 
A unit of fresh normal serum must be added, to complete the 
haemolytic system. 

Substitutes for tbe Wassermann Reaction. 

The original Wassermann reaction is difficult to per- 
form outside of a well-equipped laboratory. This has led 
to almost as many modifications, so-called, as there are work- 



Diagnosis of Syphilis. 13 

ers in this field. Many of the "modified" Wassermann tests 
are practically as difficult as the true Wassermann test, and 
are of doubtful utility. 

One of the most convenient substitutes for the Wasser- 
mann reaction is the Forges Meier test. A one per cent, emul- 
sion of lecithin in normal saline solution is mixed with an 
equal quantity of blood serum and incubated for five hours, 
and left at room temperature for twenty hours. Syphilis 
is indicated by a precipitate. Noguchi believes this test to 
be about as accurate as the Wassermann reaction. 

Noguchi Test. — Use is made of the following re-agents : 
1. Antihuman hemolytic immune body or amboceptor (serum 
from rabbit that has received injections of washed human 
corpuscles). 2. Complement (fresh guinea-pig serum). 3. 
Antigen (alcoholic extract of liver or a three per cent, solu- 
tion of lecithin in alcohol and normal saline solution). 4. Sus- 
pension of human corpuscles (one drop of normal blood 
in 4 cc. of saline solution). 5. Serum, from ten drops of 
the patient's blood. These re-agents have been prepared 
on filter paper for general use, properly standardized, and 
are said to keep indefinitely in a dry place. Absence or 
inhibition of haemolysis is regarded as a positive reaction. 
Results are reported comparable with those of Wassermann. 

Klausner Test.— A mixture of 0.2 cc. syphilitic serum 
and 0.7 cc. distilled water, gives a well-marked precipitate 
in from one to 15 hours ; normal serum gives a slight precipi- 
tate only after 24 hours. Emphasis is laid on the use of the 
exact proportions of serum and water, 2:7. Nobl regards this 
test as less decisive than the Porges-Meier test, which he be- 
lieves comparable to the Wassermann test. 

The Mayer and Proescher test is as complicated as the 
original Wassermann test, over which it does not seem to 
have any practical advantage. It consists in the use of 
sodium oleate as an antigen, and rabbit's blood immunized 
against corpuscles of the calf, to supply the immune body 
or amboceptor. Sheep's corpuscles are used for lysis, and 
guinea-pig serum to furnish complement. 



14 Diagnosis of Syphilis. 

The Fleming test utilizes, (1) alcoholic heart extract, 
(2) blood serum, and (3) washed sheep's corpuscles. This 
uses only a small amount of human serum, and does not re- 
quire an immune serum. It is based on the normal hemolytic 
action of human serum on sheep's corpuscles, a characteristic 
that is variable and sometimes absent in the human blood. 
That is to say, the patient's blood may be relied upon to 
furnish the complement, but the amboceptor for sheep's cor- 
puscles is sometimes absent in human blood. 

Brieger * substitutes potassium chlorate for the hemolysin 
such as is obtained in the serum of rabbits that have received 
injections of sheep corpuscles. In the examination of sixty- 
five syphilitic and non-syphilitic cases, the findings were the 
same as when the Wassermann reaction is used. 

The Wassermann reaction should not be judged by stat- 
istics emanating from examinations that have been made by 
quasi Wassermann methods, so-called modifications of the 
Wassermann test. Some observers have reported finding the 
reaction in other protozoal infections, such as malaria, sleep- 
ing sickness, framboesia tropica, and in scarlet fever. Wasser- 
mann has recorded over a thousand cases in which the reaction 
was negative in non-syphilitics, and his observations have re- 
ceived ample confirmation. 

Bruck t insists that all the modifications of the Wasser- 
mann method are unreliable and should not be permitted to 
replace the original Wassermann-Neisser-Bruck technic. He 
attributes the positive reactions reported in diseases other 
than syphilis, such as framboesia tropica and leprosy, to 
faulty technic. 

A positive reaction may not be expected before the sixth 
week after infection, and indicates the general reaction of the 
body to the virus. The reaction is less likely to be found when 
the symptoms are slight or the disease is being actively 



* ( L. Brieger and H. Renz, Cblorsaures Kali bei der Serodiagnose der 
Syphilis, Deutsche medizinische Wochenschrift, Dec. 16, 1909.) 

t Die Serodiagnose der Syphilis, Dr. Carl Bruck, Privatdozent und 
Oberarzt, Dermatologische Universitatsklinik, Breslau. Berlin, Julius 
Springer, 1909. 



Diagnosis op Syphilis. 15 

treated. In the "parasyphilitic" affections, the Wassermann 
reaction is often present, indicating that they are really cases 
of syphilis. Thus, Plaut obtained the reaction in one hundred 
and fifty-six cases of general paralysis, and in one hundred 
and thirty-nine out of one hundred and forty-seven cases in 
which the cerebrospinal fluid was examined; and Mott in 
forty-one out of forty-six cases of lumbar puncture. Plaut 
regards a negative finding in the cerebrospinal fluid as evi- 
dence that the disease is undergoing slow progress or tending 
to show remissions. The Wassermann reaction has also been 
found in a large proportion of cases of locomotor ataxia 
(Schiiltze), and in the paralytic and mental conditions where 
the condition seems to be due to hereditary syphilis. 

The Wassermann reaction is not always found in un- 
doubted cases of syphilis. Kaplan found the Wassermann 
reaction absent in seven per cent, of cases of syphilis, and 
the Noguchi test absent in eight per cent, of cases. 

J. Stopezanski,* from an experience with the Wasser- 
mann test in 103 cases of various dermatological affec- 
tions, found that the usual symptoms of syphilis disappear 
under specific treatment more readily than the serum reaction. 

Drever and Meirowsky (Deutsch med. Wochenschr., 1909, 
xxxv, 1698) applied the Wassermann reaction in one hundred 
registered prostitutes in Cologne. One feature of his find- 
ings is especially interesting. Fifty-six gave a syphilitic 
history, but in only one case did physical examination reveal 
manifest lesions. The Wassermann reaction was found in 
forty-five of these cases. In the remaining forty-three cases, 
that gave neither a history nor physical signs of syphilis, 
the Wassermann reaction indicated the presence of syphilis 
in thirty-two cases. Altogether, in the one hundred cases, 
gross lesions were found in only two cases, and the Wasser- 
mann reaction was present in seventy-seven cases. This agrees 
with the common observation, that practically all prostitutes 



* Beobachtungen iiber die Diagnose der Syphilis vermittels der Was- 
sermannschen Eeaktion, Wiener klinische Woehenschrift, xxii, No. 47, p. 
1623-1662, Nov. 25, 1909. 



16 Diagnosis op Syphilis. 

become syphilitic within three years. It has been claimed 
that chronic syphilis is often not contagious. Of course, 
not everybody exposed to infection of any kind becomes in- 
fected, but the only safe course is to regard all bearers of 
the spirochete pallida as extremely dangerous. 

Thomsen* found the Wassermann reaction in the human 
milk soon after delivery, but in many cases the reaction 
disappeared in a short time. He claims to have found a 
reaction in the milk in some non-s3'philitic cases, the reaction 
in these cases not being so pronounced as in the syphilitic 
cases. 

Conflicting results have been obtained upon applying the 
Wassermann reaction post-mortem, indicating that the reac- 
tion is a biologic phenomenon. This observation has been 
confirmed by Krefting f in the examination of one hundred 
cadavers. 

Meiostagmin Reaction. 

Intensely interesting is the observation by Ascoli, that 
the drop-forming property of the body fluids becomes modi- 
fied in certain pathologic conditions. Ascoli did some work 
along this line in typhoid fever and cancer. Izar J applied this 
method of examination in twelve cases of syphilis and fourteen 
non-syphilitics. The name of the reaction is derived from the 
Greek, "smaller" and "drop." For the antigen, Izar used 
an alcoholic extract of the spleen of a syphilitic fetus. 0.5 
gm. of pulverized spleen was mixed with 50 cc. of alcohol, 
incubated for two hours, filtered and evaporated to 10 cc, 
and diluted to a one per cent, solution with 0.85% salt 
solution for use. A one per cent, solution of blood serum 
is made with the same salt solution. The number of 
drops contained in 9 cc. of the diluted serum is determined, 



* Wassermann-Reaktion med. Maelk, O. Thomsen, Hospitalstidende, 
lii, No. 41, p. 1289-1320, October 13, 1909. 

t Ligsera og den Was9ermann'ske syfilisreaktion, R. Krefting, Xor^k 
Magazin for La»gevidenskaben, January, 1910. 

} G. Izar, Spezifische Eigensehaft leutiseher Blutsera, Munchener medi- 
zinisehe Wochenschrift, Januarv 25, 1910. 



Diagnosis of Syphilis. 17 

then 1 cc. of the diluted antigen is added, and the mixture 
is incubated at 37° C. for two hours. The number of drops 
is then again determined. From two to five more drops are 
found after the addition of the antigen. Izar found the 
reaction negative in two cases of leprosy, in which a positive 
Wassermann reaction had been reported. 

BIBLIOGRAPHY OF SPIROCHETE PALLIDA 
AND SERUM REACTION. 

Baetzman. Die bedeutung der Wassermannschen serum reaktion 

fur die differential diagnose der chirurgischen syphilis, 

Munch, med. Woch., 1909, s. 330-334. 
Ballner F. and von Decastello A. Ueber die klinisceh verwert- 

barkeit der komplementbindungsreaktion fiir die serodiag- 

nostik der syphilis, Deutsche med. Woch., 1908, Bd. 

xxxiv, s. 1923. 
Baly, H. W. The serum diagnosis of syphilis, an analysis 

of 200 consecutive sera examined for the Wassermann 

reaction in which a modified Neisser's technique was used, 

Lancet, Lond., 1908, i, 1523. 
Bauer, J. Ueber die worksam korper bei der Wassermannschen 

luesreaktion und ueber die haemolytischen eigenschaften 

der organextrakte, Biochem. Ztschr. Berl., 1908, Bd. 

x, s. 301-313. 
Bauer, J. Zur methodik des serogischen luesnachweises 

Deutsche med. Woch., 1908, Bd. xxxiv, s. 698. 
Bauer, J. Zum wessen der Wassermannschen luesreaktion 

Berl. Klin. Woch., 1908, Bd. xlv, s. 834. 
Bauer, J. Simplification de la technique du serodiagnostic 

de la syphilis, Semaine med., Paris, 1908, xxviii, 429. 
Beneke, R. Zur Wassermannschen luesreaktion, Berl. Klin. 

Woch., 1908 s. 730. 
Bering, F. Die praktische bedeutung der serodiagnosetik 

bie lues, Munch, med. Woch., 1908, s. 2476. 
Bertin & Petit, G. Recherches sur le sero-diagnostic de la 

syphilis, Echo med. du nord, Lille, 1908, xii, 241-245. 



18 Diagnosis of Syphilis. 

Blank. Die bewertung der Wassermannschen reaktion fur 

die behandlung der syphilis, Berl. Klin. Woch., 1909, 

1652. 
Blaschko, A. Die bedetung der sero-diagnostik fiir die 

pathologie und therapie der syphilis, Berl. Klin. Woch., 

1908, xlv, 694. 
Blaschko, A. Die bedeutung der sero-diagnostik der syphilis 

fiir die praxis, Med. klin., Berlin, 1908, iv, 1179. 
Blaschko. Ueber die klinische verwertung der Wassermann- 
schen reaktion, Deut. med. Woch., 1909, 383. 
Blumenthal. Serum-diagnostik bei syphilis, Berl. Klin. Woch., 

1908, Bd. xlv, s. 572. 
Blumenthal & Roscher. Ueber die bedeutung der Wasser- 
mannschen reaktion bei der syphilis wiihrend der ersten 

der infektion folgenden jahre, Med. Klin. Berlin, 1909, 

241. 
Boas. Die bedetung der Wassermannschen reaktion fiir die 

tberapie der syphilis, Berl. klin. Woch., 1909, 588. 
Bonnard & Mauriac. Recherche du spirochete dans les tissus 

des heredosyphilitiques, Jour, de med. de Bordeaux, 1908, 

tome xxxviii, 636. 
Breakey, J. F. The influence of the discovery of the 

spirochete pallida on the treatment of syphilis, Jour. 

Amer. Med. Assn., 1908, li, 2034. 
Bruck, C, & Stern, M. Die Massermann-Neisser-Brucksche 

reaktion bei syphilis, Deut. med. Woch., 1908, 401, 459, 

504. 
Bruck, C. Die sero-diagnostik der syphilis nach Wassermann 

Neisser und Bruck, Arch. f. Dermat. u. Syph., Wien 

u. Leipz., 1908 Bd. xci, s. 337,354. 
Von Brezovski, E. Die serum-reaktion der syphilis, Wien 

Klin. Woch, 1908, Bd. xxi, s. 1700-1743. 
Bruhns, C. Zur praktischen bedeutung der sero-diagnostik 

der syphilis, Berl. klin. Woch., 1909, 149. 
Bue, V., and Petit, E. Sur la presence du spirochete dans 

les tissus des heredo-syphilitiques, Echo med. du nord, 

Lillie, 1908, tome xii, 205. 






Diagnosis of Syphilis. 19 

Bunzel. Zur sero-diagnose der lues in der geburtshiilfe, Wien. 
klin. Woch., 1909, 1230. 

Buraszynski, A. Ikterus im Friihstadium der Lues, Wien. 
klin. Rundschau, 1907, Bd. xxi, s. 651, 699. 

Buschke & Harder. Ueber die provokatorische wirkung von 
sublimatinj ektionen und deren beziehungen zur Wasser- 
mannschen reaktion bei syphilis, Deut. med. Woch., 
1909, 1139. 

Butler, W. J. Serum-diagnosis of syphilis N. York Med. 
Jour., 1907, vol. lxxxvi, p. 1018. 

Butler, W. J., and Mefford, W. T. Precipitate reactions with 
lecithin sodium glycocholate and sodium taurocholate for 
the diagnosis of syphilis, N. York Med. Jour., 1908, 
vol. lxxxviii, p. 822. 

Butler, W. J. The serum diagnosis of syphilis and its clinical 
value, N. York Med. Jour., 1909, vol. lxxxix, p. 207-213. 

Campana, R. Una propagine della siero-diagnosi nella sifilide, 
Riforma med., Napoli, 1908, xxiv, 832. 

Chlenoff, M. A. Serum diagnosis of syphilis, Russk. Vrach, 
St. Petersb., 1908, vii, 253, 297, 407, 480. 

Citron, J. Demonstration einer neuen methode zur sero-diag- 
nostik der lues, Berl. klin. Woch., 1908, Bd. xlv, s. 469. 

Citron, J., and Reicher, K. Untersuchungen ueber das fetts- 
paltungsvermogen syphilitscher sera und die bedeutung 
der lipolyse fur die sero-diagnostik der lues, Berl. klin. 
Woch., 1908, Bd. xlv, s. 1398. 

Coenen, H. Die praktische bedeutung des serologischen syph- 
ilis nachweises in der chirurgie Beitr. z. klin. Chir., 
Tubing, 1908, Bd. lx, s. 265-295, 3 pi. 

Cohen, C. Die sero-diagnose der syphilis in der ophthal- 
mologic, Berl. klin. Woch., 1908, Bd. xlv, s. 877-882. 

Coles, A. C. Spirochete pallida ; methods of examination and 
detection, especially by means of the dark-ground illumina- 
tion, Brit. Med. Jour., Lond., 1909, i, 117-1120. 

Crendiropoulo, M. Sur le mecanisme de la reaction Bordet- 
Gengou, Ann de l'inst. Pasteur, Paris, 1908, tome xxii, 
728-751. 



20 Diagnosis of Syphilis. 

Danielopolu, D. Seroreaction de la syphilis dans les affections 

de l'aorte et des arteres, Compt. rend. soc. de biol., Paris, 

1908, tome lxiv, 971. 
Donath, K. Der heutige stand der sero-diagnostik bei syphilis, 

Munch, med. Woch., 1909, 946. 
Duperie. Heredo-syphilis tardive ; presence du spirochete 

dans le liquide cephalo-rachidien, Gazette hebdomadaire 

des Sciences Medicales de Bordeaux, November 7, 1909. 
Ehrlich & Lenartowicz. On the methods of staining the 

spirochete paUida for diagnostic purposes, Prezl. lek 

Krakow, 1908, xlvii, 33-35. 
Ehrlich, H., & Lenartowicz, J. T. Ueber farbungen der 

spirochete pallida fur diagnostiche zweck, Wien. med. 

Wochenschr, 1908 Bd. lviii, s. 1018. 
Elias, H., et el. Theorretisches ueber die serum-reaktion auf 

syphilis. Wien. klin. Woch., 1908, xxi, 748-752. 
Erdman, B. A further note on spirochete pallida. Indiana 

Med. Jour., Indianapolis, 1908-9, vol. xxvii, p. 147. 
Ewing, J. Note on involution forms of spirochete pallida 

in gummata, Proc. N. York Path. Soc, 1907-8, ns. vii, 

166-171. 
Fischer, W., & Meier, G. Ueber den klinischen wert der 

Wassermannschen sero-diagnostik bei syphilis. Deutsche 

med. Woch., 1907, Bd. xxxiii, s. 2169. 
Fischer, W. Klinische betrachtungen ueber die Wasser- 

mannsche reaktion bei syphilis. Berl. klin. Woch., 1908, 

Bd. xlv, s. 151. 
Fleischmann. Zur theorie und praxis der serum-diagnosis der 

syphilis. Berl. Klin. Woch., 1908, 490-494. 
Fleischmann, P. Die theorie, praxis und resultate der serum- 

diagnostik der syphilis. Dermat. Centralbl., Leipzig, 

1908, Bd. xi, s. 226-258. 
Fleming, A. Demonstration of a simple method of serum 

diagnosis of syphilis by the complement deviation method. 

Proc. Roy. Soc. Med., London, 1908-9, ii, clin. sect., 

220-225. 



Diagnosis of Syphilis. 21 

Fleming. The serum diagnosis of syphilis. Brit. Med. Jour., 

London, 1909, ii, 984. 
Fleming, A. A simple method of serum diagnosis of syphilis. 

Lancet, London, 1909, vol. i, p. 1512. 
Flexner, S. Demonstration of treponema pallidum with the 

dark-field illumination miscroscope, Proc. N. York Path. 

Soc, 1907, ns, vii, 207-210. 
Fornet. Technique de divers procedes employes pour le sero- 

diagnostic de la syphilis, Semaine Med., Paris, 1908, 

tome xxviii, 217. 
Fornet. A practical description of the various methods em- 
ployed in the sero-diagnosis of syphilis, Med. Press & 

Circ, London, 1908, ns, lxxxvi, 138-140. 
Fornet, W. Die Wassermann A. Neisser-Brucksche reaktion 

bei syphilis. Deut. med. Woch., 1908, Bd. xxxiv, s. 830. 
Fouquet, C. Note sur la presence de treponemes pales de 

Schaudinn dans l'appendice d'un foetus heredo-syphilitique. 

Ann. d. mal ven., Paris, 1908, tome i, 38. 
Fox, H. A. A comparison of the Wassermann and Noguchi 

complement fixation test, Jour. Cutan. Dis., N. Y., 1909, 

vol. xxvii, 338-351. 
Fox, H. The principles and technique of the Wassermann 

reaction and its modifications, Med. Rec, N. Y., 1909, 

vol. lxxv, p. 421-428. 
Fox. The principles and technic of the serum diagnosis of 

syphilis, Am. Med., 1909, ns, iv, 152-154. 
Fraenkel, E., & Much, H. Ueber die Wassermannsche sero- 

diagnostik der syphilis, Munch, med. Woch., 1908, 602. 
Fraenkel & Much. Die Wassermannsche reaktion an der 

leiche, Munch, med. Woch., 1908, 2479. 
Fritz, W., & Kren, O. Ueber den wert der serum-reaktion 

bei syphilis nach Porges, Meier und Klausner, Wien. klin. 

Woch., 1908, Bd. xxi, s. 386. 
Gastou, P. Diagnostic de la syphilis par l'ultramicroscope. 

Presse Med., Paris, 1908, tome iii, 274-290. 
Gay, F. P. The serum diagnosis of syphilis, Bost. Med. 

& Surg. Jour., 1909, vol. clxi, p. 432. 



22 Diagnosis op Syphilis. 

Gay and Fitzgerald. The serum diagnosis of syphilis. Bost. 

Med. & Surg. Jour., 1909, vol. clx, p. 157. 
Geraghty, J. T. The practical value of the demonstration 

of spirochete pallida in the early diagnosis of syphilis, 

Johns Hopkins Hosp. Bull., Baltimore, 1908, vol. xix, 

p. 364. 
Geraghty, J. T. The practical value of demonstrating spi- 
rochete pallida as an aid in the early diagnosis of syphilis. 

Maryland Med. Jour., 1908, vol. li, p. 159. 
Golestein, O. Welche bedeutung hat die serum-diagnostik der 

syphilis im genenwartigen stadium fur den praktiker? 

Prag. med. Woch., 1908, Bd. xxxiii, s. 461. 
Gross, S., & Yolk, R. Sero-diagnostische untersuchungen bei 

syphilis, Wien klin. Woch., 1908, Bd. xxi, s. 647. 
Grosser. Wert und praktische bedeutung der sero-diagnostik 

bei lues. Med. Klin., Berlin, 1909, 1343-1350. 
Grosz and Yolk. Weitere sero-diagnostische untersuchungen bei 

syphilis, Wien klin. Woch., 1908, 1522. 
Grouven, C. Ueber klinisch erkenbare allgemeinsyphilis beim 

kanischen, Dermat. Ztschr., Berlin, 1908, Bd. xv, s. 

209-215. 
Grouven, C. Ueber den nachweis der spirochete pallida bei 

kongenitaler syphilis, Zentralbl, f. Gynakol., Leipzig, 

1908, Bd. xxxii, s. 581. 

Harris and Corbus. The clinical value of the spirochete pallida 

in the diagnosis and treatment of syphilis. J. Am. M. 

Assn., 1908, vol. li, p. 1928. 
Hedren, G. Untersuchungen ueber spirochete pallida bei 

kongenitaler syphilis, Centralbl. f. Bakteriol., 1 Abt., 

Jena, 1908, Bd. xlvi, Orig, s. 232-247. 
Hauck, L. Zur frage des klindischen wertes der Wassermann- 

Neusser-Bruckschen syphilis reaktion, Munch med. Woch, 

1909, 1265. 

Hecht. Lichen lueticus mit negativer Wassermannscher reak- 
tion, Deut. med. Woch., 1909, 1677. 

Hecht and Wilenko. Ueber die untersuchung der spirochete 
pallida mit dem treschverfahren, Wien klin. Woch, 1909, 
932. 



Diagnosis op Syphilis. 23 

Hinrichs, W. Der serologische luesnachweis mit der Bauer- 

schen Modifikation der Wassermannschen Reaktion, Med. 

Klin, Berlin, 1908, Bd. iv, s. 1349. 
Hoehne, F. Die serum-diagnose der syphilis, Dematol. Ztschr., 

Berlin, 1908, Bd. xv, s. 146-154. 
Hoehne, F. Ueber das verhalten des serums von scharlach- 

kranken bei der Wassermannschen reaktion auf syphilis, 

Berl. klin. Woch., 1908, Bd. xlv, s. 1717-1719. 
Hoehne, F. Ueber die verwendung von urin zur Wasser- 
mannschen syphilis-reaktion, Berl. klin. Woch., 1908, Bd. 

xlv, s. 1488. 
Hoehne, F. Was leistet zur zeit die Wassermannsche reaktion 

fur die praxis? Med. Klin., Berlin, 1908, Bd. iv, s. 1787. 
Hoehne, F. Die Wassermannsche reaktion und ihre beeinflus- 

sung durch die therapie, Berl. klin. Woch., 1909, 869. 
Hoffmann, E., & Blumenthal, F. Die sero-diagnostik der 

syphilis und ihre verwertbarkeit in der praxis, Dermat. 

Ztschr., Berlin, 1908, Bd. xv, s. 23-26. 
Hutchinson, J. Experimental syphilogy, Brit. Med. Jour., 

London, 1908, vol. ii, p. 1215. 
Jesionek and Meirowsky. Die practische Bedeutung der 

W. N. B. Reaktion, Miinchener medizinische Wochen- 

schrift, No. 45, November, 1909, s. 2297. 
Jancke. Die spirochete pallida und der cytorrhyktes lues, 

Therap. Monatsh., Berlin, 1908, Bd. xxii, s. 79. 
Jochmann & Topfer. Zur frage der specifizitat der komple- 

mentbindungsmethode bei der syphilis, Miinchen. med. 

Woch., 1908, Bd. Iv, s. 1690. 
Karewski, F. Ueber die bedeutung der Wassermannschen 

syphilis-reaktion fur die chirurgische differential-diagnose. 

Berl. klin. Woch., 1908, Bd. xlv, s. 15. 
Klausner, E. Vorlaufige mitteilung ueber eine methode der 

serum-diagnostik bei lues, Wien. klin. Woch., 1908, 214. 
Klausner, E. Eine methode der serum-diagnostik bei lues, 

Wien. klin. Woch., 1908, 363. 
Knoepfelmacher, W., and Lehndorff, H. Komplementalblenkung 

bet. Muttern hereditarluetischer sauglinge, Mitt. d. 



24 Diagnosis of Syphilis. 

Gessellsch. f. inn. Med. u. Kinderh. in Wien, 1908, Bd. 

vii, s. 82. 
Konig. Warum ist die hechtsche modification der Wasser- 

mannschen luesreaktion dieser und der sternschen modifi- 

kation vorzuziehn, Wien. klin. Woch., 1909, 1127. 
Kopp, C. Ueber die bedeutung der Wassermannschen sero- 

diagnose der syphilis fur die praxis, Munch, med. Woch., 

•1909, 957. 
Kroner, K. Ueber der diffcrentiell-diagnostischen wert der 

Wassermanschen sero-diagnostik bei lues fiir die innere 

medizin und die neurologic, Berl. klin. Woch., 1908, Bd. 

xlv, s. 1491. 
Kuster, E. Die sero-diagnosis der lues, Aerztl. Mitt, a Baden 

Karlsruhe, 1908, Bd. lxii, s. 147. 
Lang, E. Die spirochsete pallida und die klinische forchung 

nebst betrachtungen ueber syphilistherapie, etc., Wien. 

klin. Woch., 1908, 1653-1709. 
Ledermann, R. Ueber den praktischen wert der sero-diag- 
nostik bei syphilis, Deutsche med. Woch., 1908, Bd. 

xxxiv, s. 1760. 
Ledermann, R. Ueber die bedeutung der Wassermannschen 

serum-reaktion fiir die diagnostik und behandlung der 

syphilis, Med. Klin., Berlin, 1909, 419. 
Lesser, F. Zu welchen schlussen berechtigt die Wassermannsche 

reaktion? Sero-diagnostik der syphilis, Med. Klin., Ber- 
lin, 1908, 299. 
Lesser. Weitere ergebnisse der sero-diagnostik der syphilis. 

Deut. med. Woch., 1909, 379, Disc. 417. 
Levaditi, C. Les nouveaux moyens de diagnostic de la syphilis, 

Annales de Dermatologie et de Syphiligraphie, fevrier, 

mai, et avril, 1909. 
Levaditi, C, Laroche & Yamanouche. Le diagnostic precoce 

de la syphilis par la methode de Wassermann, Compt. 

rend. Soc. de biol., Paris, 1908, tome lxiv, 720. 
Levaditi, C, & Yamanouchi, T. Recherches sur l'incubation 

dans la syphilis, Comp. rend. Soc. de Biol., Paris, 1908, 

tome lxiv, 50. 



Diagnosis op Syphilis. 25 

Levaditi, C. Le sero-diagnostic de la syphilis, Clin. Ophth., 
Paris, 1908, tome xiv, 73. 

Levaditi, C, & Yamanouchi, T. Le sero-diagnostic de la 
syphilis, Compt. rend. Soc. de Biol., Paris, 1907, tome 
lxiii, 740. 

McDonaugh. Serum diagnosis of syphilis. Practitioner, Lon- 
don, 1909, vol. lxxxiii, p. 307-326. 

Mcintosh. On the presence of the spirochete pallida (trepon- 
ema pallidum) in the ova of a congenital syphilitic child. 
Centralbl. f. Bak. i Abt., Jena, 1909, Bd. li, Orig. 

Mcintosh, J. The occurrence and distribution of the spiro- 
chete pallida in congenital syphilis. J. Path. & Bact., 
London, 1908-1909, vol. xiii, p. 239. 

Mcintosh, J. The sero-diagnosis of syphilis, Lancet, London, 
1909, vol. 1, p. 1515-1521. 

MacLenan, A. The place of the spirochete pallida in the 
diagnosis of syphilis. Brit. Med. Jour., London, 1907, 
vol. ii, p. 1510. 

Malinowski, F. Spirochete pallida bei tertiarer syphilis, Mo- 
natschr. f. prakt. dermat., Hamburg, 1907, Bd. xlv, 
s. 499. 

Marchildon, J. W. The theory, technic and practical results 
of the reaction for the serum diagnosis of syphilis, St. 
Louis Med. Rev., 1908, vol. lvii, p. 376. 

Marie, A. Controle de Wassermann et traitement specifique 
des para-syphilitiques, Rev. prat. d. mal cutan., Paris, 
1908, tome vii, 95-101. 

Maslakowetz, P. P., and Liebermann, J. J. Theorie und 
technik der reaktion von Wassermann und die diag- 
nostische bedeutung derselben, Centralbl. f. Bakteriol. 1 
Abt., Jena, 1908, Bd. xlvii, Orig, s. 379-393. 

Mayer, E. E., & Proescher, F. The serum diagnosis of syph- 
ilitic diseases, Arch. Int. Med., Chicago, 1908, vol. ii, 
p. 55. 

Meier, G. Die technik zu verlassigkeit und klinsche bedeutung 
der Wassermannschen reaktion auf syphilis, Berl. klin. 
Woch., 1907, Bd. xliv, s. 1636-1642. 



26 Diagnosis of Syphilis. 

Meirowsky, E. Die schurmannsche methode des luesnach- 

weises mittelst farbenreaktion. Deut. med. Woch., 1909, 

937. 
Meirowsky, E. Ueber die von Bauer vorgeschlagene technik 

der Wassermann A. Neisser-Bruckschen reaktion. Berl. 

klin. Woch., 1909, 152. 
Meierowskv. Ueber die von M. Stern vorgeschlagene modifi- 

kation der Wassermann A. Neisser-Bruckschen reaktion, 

Berl. klin. Woch., 1909, 1310. 
Meyer, O. Zur frage der silberspirochaste, Centbl. Bak. 1 Abt., 

Jena, 1908, Bd. xlvi, Oirg, s. 319-321. 
Michaelis, L. Pracipitinreaktion bei syphilis, Berl. klin. Woch., 

1907, Bd. xliv, s. 1477. 

Michaelis, L., & Lesser, F. Erfahrungen mit der sero-diag- 
nostik der syphilis, Berl. klin. Woch., 1908, Bd. xlv, 
s. 301. 

Micheli, F., & Borelli, L. Osservazioni e ricerche sulla siero- 
zione di Wassermann), Gior. d. r. Accad. di med. Torino, 

1908, 4 s. xiv, 16-19. 

Micheli, F., & Borelli, 1.. Osservanzioni e ricerche sulla siero- 

diagnosi della sifilide, Riv. crit. di clin. med., Firenze, 

1908, ix, 289, 30.5. 
Much, H. Eine studie ueber die sogenannte komplementbin- 

dungsreaktion mit besonderer berucksichtigung der lues, 

Med. Klin, Berlin, 1908, Bd. iv, s. 1076. 
Much. Die practische brauchbarkeit der Wassermannschen 

reaktion, Miinch. med. Woch., 1909, 1485. 
Mucha, V. Zur differential diagnose zwischen Lues und Tu- 

berkulose bei ulzerosen prozessen, Arch. f. Dermat. u. 

Syph., Wien. u. Leipz., 1908, Bd. lxxxix, s. 355-380. 
Much, V. Ueber den nachweis der spirochete pallida im 

dunkelfeld, Med. Klin., Berlin, 1908, Bd. iv, s. 1498. 
Muhsam, H. Die klinische leistungfahigkeit der sero-diag- 

nostik bei lues, Berl. klin. Woch., 1908, Bd. xlv, s. 14. 
Muller, R. Zur verwertbarkeit und bedeutung der komple- 

mentbindungsreaktion fiir die diagnose der syphilis, Wien. 

klin. Woch., 1908, Bd. xxi, s. 282. 



Diagnosis op Syphilis. 27 

Muller, R. Die bedeutung der sero-diagnose der syphilis fur 

den arzt, Wien. med. Woch., 1908, 2796. 
Murty, C. W. The use of a printed chart in the serum 

diagnosis of syphilis. N. York Med. Jour., 1909, vol. 

lxxxix, p. 954. 
Neubauer, Elias (et al). Ueber die spezifizat der Wasser- 

mannschen syphilisreaktion. Wien. klin. Woch., 1908, 

Bd. xxl, s. 652. 
Noble and Arzt. Zur sero-diagnostik der syphilis. Wien. 

klin. Woch., 1908, Bd. xxi, s. 287. 
Noguchi. The sero-diagnosis of syphilis. J. Am. M. Assn., 

1909, vol. liii, p. 934. 
Noguchi & Moore. The butyric acid test for syphilis in 

the diagnosis of metasyphyilitic and other nervous dis- 
orders, Jour. Exp. Med., Lancaster, Pa., 1909, vol. xi, 

p. 604-613. 
Noguchi. Eine fur die praxis geeignete leicht ausfiihrbare 

methode der serumdiagnose bei syphilis. Munch, med. 

Woch., 1909, 494. 
Opitz, E. Ueber die bedeutung der Wassermannschen lues- 

reaktion fur die geburtshiilfe. Med. Klin., Berlin, 1908, 

Bd. iv, s. 1137. 
Parvu, M. Le sero-diagnostic de la syphilis, Tribune Med., 

Paris, 1908, 2s, tome xl, 566-568. 
Pedersen. Notes bearing on the value of the Wassermann 

test, Post Grad., N. Y., 1909, vol. xxiv, p. 679. 
Pick, L., & Proskauer, A. Die komplementbindung als hilf- 

smittel der anatmonischen syphilis diagnose, Med. Klinik, 

Berlin, 1908, Bd. iv, s. 539. 
Plant, F. Sero-diagnostik der syphilis. Zentralbl. f. Ner- 

venh. u. Psychiat., Leipzig, 1908, Bd. xxxi, s. 289. 
Plaut, F., Heuck, W., & Rossi. Gibt es eine spezifische 

prazipitalreaktion bei lues und paralyse? Miinchen. 

med. Woch., 1908, Bd. Iv., s. 66. 
Porges, O., & Meier, G. Ueber die rolle der lipoide bei 

der Wassermannschen syphilis-reaktion, Berl. klin. Woch., 

1908, Bd. xlv, s. 731. 



28 Diagnosis of Syphilis. 

Prowazek. Bemerkungen zur spirochaten und vaccinefrage, 

Centbl. f. Bakter. 1 Abt., Jena, 1908, Bd. xlvi, Orig, 

s. 229. 
Purckhauer, R. Wie wirkt die spezifische therapie der Was- 

sermann A. Neisser-Brucksche reaktion ein? Munch, med. 

Woch., 1909, 608-702. 
Quinby, W. C. The demonstration of the spirochete pallida 

by the method of dark-field illumination. Bost. Med. 
& Surg. Jour., 1908, vol. clix, p. 175. 
Rajat. Le sero-diagnostic de la syphilis, Centre med. et 

pharm., Gannat, 1908-9, tome xiv, 36. 
Rondoni, P. Beitrage zur theorie und praxis der Wasser- 

mannschen syphilis-reaktion 1 Mitteilung ueber den ein- 

fiuss der extraktivverdiinnung auf die reaktion, Berl. klin. 

Woch., 1908, Bd. xlv, s. 1968. 
Rosenberger, R. C. The present status of the aetiology of 

syphilis, the spirochete pallida, its biology and etiological 

relation to the disease, N. York Med. Jour., 1908, vol. 

lxxxvii, p. 391. 
Sachs, H., & Altmann, K. Ueber die Wassermannsche sero- 

diagnostik der syphilis, Deut. med. Woch., 1908, 529. 
Sachs & Altmann. Ueber die wirkung des oleinsauren natrons 

bei der Wassermannschen reaktion auf syphilis, Berl. 

klin. Woch., 1908, 494. 
Schalek. A practical value of modern conceptions of syphilis. 

J. Am. Med. Assn., 1908, 50, 1409-1411. 
Scheidemandel. Ueber die Wassermannsche sero-diagnostik 

der lues. Miinchen. med. Woch., 1908, Bd. lv, s. 2017. 
Schereschewsky, J. Zuchtung der spirochete pallida (Schau- 

dinn), Deut. med. Woch., 1909, 835. 
Scheuer. Fruhdiagnose der syphilis mittelst nachweises der 

spirochete pallida im dunkelfeldapparate. Wien. med. 

Woch., 1909, 1947. 
Schlimpert. Beobachtungen bei der Wassermannschen reak- 
tion. Deut. med Woch. 1909, 1386. 
Soutzo fils. Les nouvelles donnees relatives a la seroreaction, 

klin. Woch., 1909, 1116. 



Diagnosis of Syphilis. 29 

Shishkina-Yavelin, Mme. P. N. Serum diagnosis of syphilis, 
Russk. Vrach., St. Petersb., 1908, vii, 641-645. 

Soutso fils. Les nouvelles donnees relatives a la seroreaction 
de la syphilis dans la paralysie generale par le methode de 
Wassermann, Ann. med-psychol., Paris, 1908, 9s, tome 
viii, 52-68. 

Spillmann, L., & Lamy. A propos du sero-diagnostic de la 
syphilis interpretation d'une reaction negative chez un 
syphilitique, Compt. rend. soc. de biol., Paris, 1908, tome 
lxiv. 

Stern, M. Zur technik der sero-diagnostik der syphilis, Berl. 
klin. Woch., 1908, Bd. xlv, s. 1489. 

Stern, M. Eine Vereinfachung und Verfeinerung der sero- 
diagnostischen syphilis-reaktion, Zeitschrift fur Immuni- 
tatsforschung, 1909, s. 422. 

Stone, W. J. The early diagnosis of syphilis and the tech- 
nique of examination for the spirochete pallida. Med. 
Rec, N. Y., 1909, vol. lxxv, p. 638. 

Stone, W. J. The technic for examination for the pale spi- 
rochete by dark-field illumination, J. Am. M. Assn., 1909, 
vol. lii, p. 960. 

Swift. A comparative study of serum diagnosis in syphilis, 
Arch. Int. Med., Chicago, 1909, vol. iv, p. 376-404. 

Taege, K. Die technik der Wassermann-Neisser-Bruckschen 
sero-diagnostik der syphilis, Munchen. Med. Woch., 1908, 
Bd. Iv, s. 1730. 

Towle, H. P. The serum diagnosis of syphilis, Boston Med. & 
Surg. Jour., 1908, vol. clix, pp. 474, 502. 

Tschernogubow, N. Eine einfache methode der serum-diagnose 
bei syphilis, Berl. klin. Woch., 1908, Bd. xxvi, s. 2107. 

Tschernogubow, N. A. Ein vereinfachtes verfahren der serum- 
diagnose bei syphilis, Deut. med. Woch., 1909, 668. 

Vadam, P. Les methodes de laboratoire appliquees a la clin- 
ique methodes bacterioscopiques confirmant le diagnostic 
de la syphilis, Medicin Prat, Paris, 1908, tome iv, 293. 

Wassermann, A. Ueber die entwicklung und den genenwartigen 
stand der sero-diagnostik geneniiber syphilis, Berl. klin. 
Woch., 1907, Bd. xliv, s. 1599, 1634. 



30 Diagnosis op Syphilis. 

Wassermann, A. Ueber die sero-diagnostik bei syphilis, Wien. 
klin. Woch., 1908, Bd. xxi, s. 388. 

Wassermann, A. Ueber die sero-diagnostik der syphilis und 
ihre praktische bedeutung fiir die medizin, Wien. klin, 
Woch., 1908, Bd. xxi, s. 7-15. 

Wassermann, A. Ueber die sero-diagnostik der syphilis und 
ihre praktische bedeutung fiir die medizine, Heilkunde 
Berl., 1908, 349-354. 

Wechselmann. Postkonzeptionelle syphilis und Wassermannsche 
reaktion, Deut. med. Woch., 1909, 665. 

Weil, E., & Braun, H. Ueber antikorperbefunde bei lues 
tabes und paralyses, Berl. klin. Woch., 1907, 1570. 

Weil, E., & Braun, H. Ueber die entwicklung und den geneg- 
wartigen stand for der sero-diagnostik genenuber syphilis, 
Berl. klin. Woch., 1907, 1682. 

Weil, E., & Braun, H. Ueber die entwicklung der sero-diag- 
nostik bei lues, Wien. klin. Woch., 1908, Bd. xxi, s. 624. 

Weil, E., & Braun, H. Ueber positive Wassermann-Neisser A. 
Brucksche reaktion bei nichtleutischen erkrankungen, 
Wien. klin. Woch., 1908, Bd. xxi, s. 938. 

Weis, J. D. A rapid method of demonstration of the spi- 
rochete pallida for diagnosis, New Orleans Med. & Surg. 
Jour., 1907-8, vol. lx, p. 561 ; 1908, vol. lxi, p. 205. 

Whittemore, W. The Wassermann reaction for syphilis, Bos- 
ton Med. & Surg. Jour., 1909, vol. clx, p. 651. 

Wile, W. J. The spirochete pallida, its easy demonstrability 
and a brief review of its history, Jour. Cut. Dis., N. Y., 
1909. vol. xxvii, p. 296. 

Wilson, D. S. Diagnostic importance of the spirochaete pal- 
lida or treponema pallidum, Louisville Month. Jour. Med. 
& Surg., 1908, vol. xv, p. 69. 

Wright & Richardson. Treponemata (spirochete) in syphilitic 
aortitis, 5 cases, 1 with aneurism, Bost. Med & Surg. 
Journal, 1909. vol. clx, p. 539. 

Zalla, M. La "precipitazione" della lectitina nella sero-diag- 
nosis della sifilide a delle affezioni metasifilitiche, Riv. di 
patol. nerv., Firenze, 1908, xiii, 385-389. 



Diagnosis of Syphilis. 31 

METHODS OF INFECTION. 

Syphilis may be conveyed through inoculation. The 
abrasion need be but slight, so that it may have entirely 
disappeared by the time the patient comes under the obser- 
vation of the physician. Therefore the abrasion has often 
little diagnostic value. Infection may be transmitted through 
sexual intercourse, kissing, and through the use of common 
utensils and vessels, as for eating and drinking. No doubt 
infection may be conveyed by a contaminated water-closet seat, 
though this is comparatively rare. Physicians and nurses 
have been inoculated in the examination or treatment of cases 
of syphilis, especially in surgical and obstetrical practice. Oc- 
casionally syphilitic infection occurs during circumcision by 
an infected individual, when the operation is done after the 
fashion of the Mosaic law. All of this is of diagnostic 
import only in so far as the knowledge of the cause of the 
disease may lead to its recognition. 

Hereditary syphilis may be transmitted from either parent, 
in whom the disease may be either manifest or latent at the 
time. Syphilitic infection of a mother beginning at the 
seventh month of gestation, usually does not affect the fe- 
tus, although the fetus has been reported affected as late as 
the eighth month of gestation. The mother need not nec- 
essarily be affected by syphilis transmitted to the offspring 
from the father, and may possibly nurse the child without 
becoming infected, probably through having received a pro- 
tective inoculation without the development of the disease. 
The child may convey syphilis readily to a wet-nurse who has 
received no such protection. Jacobi states, without qualifica- 
tion, that an infant affected with hereditary syphilis will not 
infect its own mother and ought to be nursed. This is in ac- 
cordance with the observation of Colles, 1837 : 

CoIIes' Law. 

"One fact well deserving our attention is this : That a 
child born of a mother who is without obvious venereal 



32 Diagnosis of Syphilis. 

symptoms, and which, without being exposed to any infec- 
tion subsequent to its birth, shows this disease when a few 
weeks old — this child will infect the most healthy nurse, 
whether she suckle it or merely handle and dress it ; and 
yet this child is never known to infect its own mother, even 
though she suckle it while it has venereal ulcers of the lips 
and tongue." 

The mothers of infants with congenital syphilis often 
show the Wassermann reaction, without other manifesta- 
tions of syphilitic infections. 



HEREDITARY SYPHILIS. 

Hereditary syphilis and congenital syphilis are not always 
synonymous. A distinction should be made between syphilis 
acquired with conception and syphilis acquired during intra- 
uterine life. Hereditary syphilis differs from acquired syphi- 
lis essentially in the absence of the initial lesion or chancre. 
The other stages of the disease are practically analogous 
in the two forms. 

We have already referred to Colles' law. The analogue 
of this, on the part of the child, commonly known as Prof eta's 
law, is attributed to Behrend by Hutchinson. It is based 
upon the observation that apparently healthy children may 
be born of mothers in the secondary stage of syphilis. Such 
cases of congenital immunity must not be confounded with 
cases of syphilis hereditaris tarda. In the last named condi- 
tion, syphilis is acquired by heredity, but does not become 
manifest until a long time after birth. The existence of 
such cases is doubted by some observers, who are inclined 
to believe that the reported cases are really cases of acquired 
syphilis and that the initial lesion has been overlooked. 

The history or evidence of syphilis in either parent may 
shed a valuable side light in a doubtful case; but such 
evidence or history is at times misleading. In general, its 
importance corresponds to the shortness of time between 



Diagnosis of Syphilis. 33 

the infection of the parent and the time of conception. 
The probability of the disease being transmitted is greater 
when both parents are infected. 

Doubtful cases may be cleared up by finding the spirochete 
pallida, or by the Wassermann reaction. 



SPIROCHETE PALLIDA IN CONGENITAL 
SYPHILIS. 

M'Intosh found spirochete pallida in the lungs, liver, 
spleen, suprarenal gland, kidneys, and skin, in congenital 
syphilis. He declares that the large number of parasites in 
the liver, in congenital syphilis, suggests the maternal trans- 
mission of the infection through the placenta. He did not 
find the spirochete in the placenta. Levaditi found it once 
in thirteen cases, and Dohi twice in six cases. In a liver 
that had undergone maceration, no spirochetes were found, 
though the organ was studded with miliary gummata, and 
the maceration was but slight. 

Busghke and Fischer, 1905, and Levaditi, 1905-6, first 
demonstrated the spirochete pallida in the organs of a syph- 
ilitic infant. Their examinations were made with the Giemsa 
stain. The earlier examinations, made by the methods of 
Herxheimer and Hubner, 1905, and Giemsa, 1905, were only 
partially successful. Later Bertarelli, Volpino, and Bovero, 
using a modification of the van Ermenghem cilia stain, showed 
the parasites present in large numbers in the organs in con- 
genital syphilis. Probably the most satisfactory method of 
making these examinations is by the use of Levaditi's modi- 
fication of Ramon y Cajal's stain for the demonstration of 
nerve fibrils. A more rapid silver stain has been devised by 
Levaditi and Manouelian, but it is not so reliable as the other 
stain. 

Levaditi and Souvage have reported that the spirochete 
pallida may be found in the Graafian follicle, inside the 
ovum, in congenital syphilis. Direct infection of the ovum 



34 Diagnosis of Syphilis. 

without its destruction is known to occur in tick (Ornitho- 
dorus moubata), with the spread of the tick fever. 

Babes and Panea found spirochete pallida, post-mortem 
in congenital syphilitics from one to four weeks old, in three 
cases. The spirochetes were most numerous where the syphilitic 
lesions were most marked. No spirochetes were found in 
the non-syphilitic children examined. 

A series of abortions may be due to syphilis. But there 
are other causes of abortion. Only too often syphilitic 
parents have large families. Syphilis of the placenta may 
cause abortion, commonly through death of the fetus. When 
abortion takes place before the fifth month, it is often 
impossible to make a diagnosis of syphilis in the fetus. 

It has been doubted (Hutchinson) whether syphilis is trans- 
mitted to offspring by the father if an interval of two years has 
elapsed since his disease was acquired. If this is the rule, 
there are many exceptions. It is well known that mothers 
may transmit the disease after a longer period. However, 
it is a matter of observation that the older children are most 
liable to inherit the disease. The younger members of syph- 
ilitic families more frequently escape the disease. The reported 



Bales and Panea, Ueber pathologische Veraderungen und Spirocha;te 
pallida bei eongenitaler Syphilis, Berliner klinische, Wocbenscrift, xlii, 
xlii, No. 27. 

Bertarelli, Volpino. and Bovero, Riv. d'ig. e. san publ., Roma, anno 
xvi, p. 561. 1905. 

Busghke and Fischer, Deutsche med. Wochenschrift, Leipzig, 1805, 
No. 20, s. 791. 

Finger and Langsteiner. Sitzungsb, d. k. Akad. d. Wissensch., Wien, 
Heft 4. Bd. cxv, s. 179, 1905. 

Giemsa, Deutsche med. Wochenschrift. Leipzig, 1905. No. 26, s. 1026. 

Herxheimer and Hubner, Deutsche med. Wochenschrift, Leipzig. 1905, 
No. 26, s. 1023. 

Levaditi, Compt. rend. Sec. de Biol., Paris. 1905, tome Ivii, p. 845. 

Levaditi. Ann, de l'lnst. Pasteur. Paris. 1906, tome xx. p. 368. 

Levaditi and ManoueUian, Compt. rend. Soe. de biol., Paris, 1906, 
tome lviii. p. 134. 

Levaditi and Sauvage, Adad. des Sciences, Paris. 1906, tome cxliii, 
p. 559. 

Levaditi and M'Intosh, Ann. de l'lnst. Pasteur, Paris. 1907, tome xxi, 
p. 784. 

M'Intosh. James. The occurrence and distribution of the spirocheta 
pallida in congenital syphilis, Journal of Pathology and Bacteriology, 
January, 1909. 

Ramon y Cajal, Compt. rend. Soc. de biol., Paris, 1904, tome lvi, p. 368. 



Diagnosis op Syphilis. 



35 



cases of long persistence of the syphilitic taint and trans- 
mission of the disease are open to the possibility of a repe- 
tition of the infection. So-called latent syphilis can exist 
only through the fact that we do not recognize the disease. 
This may be because prominent symptoms are lacking or 
because we do not examine the patient with sufficient care. 
Such a case was reported by Hutchinson, in 1874. The 
vaccinifer had been selected at a station as a specially healthy 
child, and remained apparently such after the vaccination, 
which conveyed syphilis to sixteen individuals. A careful search 
was then instituted, which revealed a condyloma at the anus. 
Such cases, of course, would not occur with the use of modern 
virus for vaccination. 

Idiocy and mental failure seem to be more common in 
cases of hereditary syphilis than in non-syphilitic cases. 
Hutchinson believes that many of these cases are examples 
of paralytic dementia developed during childhood. It is 
doubtful whether hereditary syphilis ever causes the aggressive 
degenerations, such as locomotor ataxia. Transmission of 
this form of syphilis to the third generation has been reported, 
but is doubtful. 

It has been estimated that at least one-third of syphilitic 
children are dead-born, and that one-fourth of those born 
alive die within six months. After the first six months, the 
child with hereditary syphilis usually lives to suffer disease 
or deformity as the result of its inheritance. 

It is usually impossible to make the diagnosis of syphilis 
of the fetus in utero. Jacobi declares that it is impossible 
to make a positive diagnosis of syphilis in cases in which 
abortion takes place before the fifth month. In case of 
abortion, a syphilitic fetus may show various evidences of 
the disease, especially skin eruptions (bulla and pemphigus) 
and visceral affections (parenchymatous infiltration of the 
liver, spleen, kidneys, heart and thymus gland). 

Near the end of term there is epiphyseal osteochondritis, 
especially of the lower extremities. The spleen may show 
gummatous tumors, cicatricial tissue, and there may be ad- 
herent peritonitis. 



36 Diagnosis op Syphilis. 

At the end of term there may be palmar or plantar 
pemphigus and visceral changes of syphilis. Milder cases 
may show a pale red or brown exanthem on the face, feet, 
hands and genitals ; coryza ; rhagades of the lips and at the 
anus ; and often the spleen is enlarged. 

Abortion, especially repeated abortions, is often referred 
to as a valuable sign of syphilis. A more important sign 
is a higli infant mortality in a family, in the absence of 
any other adequate explanation of the cause of the deaths. 
Symptoms of syphilis may be present at the time of birth, 
especially : — 

Senile appearance, 

hoarseness, 

corj'za, and 

eruptions, especially pemphigus. 

At the time of birth, or soon after, icterus neonatorum 
may appear, to give a grave prognosis. Symptoms of hered- 
itary syphilis are often present at the time of birth, and 
usually may be observed during the first three months of 
life. It is not safe to base a diagnosis upon a single symp- 
tom. The important earl} - symptoms are peevishness and 
irritability at night, harsh and difficult breathing, snuffles, 
sore mouth and impaired digestion, with emaciation and the 
senile appearance. There may be characteristic eruptions, 
especially an erythema over the neck, face, extremities and 
genitals. 

During the period extending from about the end of the 
first month to about the end of the first year, cases of 
hereditary syphilis may show : — 

Nocturnal peevishness and irritability. 
Convulsions. 

Hoarseness, with harsh and difficult breathing. 
Corj'za (snuffles). 

Eruptions: erythema, papules, and pustules. 
Mucous patches, especially on the lips, tongue and 
cheeks. 



Diagnosis of Syphilis. 37 

Emaciation and senile appearance. 

Visceral affections (liver, spleen, kidneys, heart, etc.). 

Many cases of hereditary syphilis that survive this stage 
of the disease, especially if they have been properly treated, 
appear to terminate at the end of the second stage, after the 
disease has lasted about a year or eighteen months. In 
other cases, the disease remains quiescent until the second 
dentition or until puberty, or possibly even later in life. 
This period is characterized by the absence of active symp- 
toms, evidences of malnutrition, stunted growth, and retarded 
development. 

Later important symptoms of hereditary syphilis are: — 

Hutchinson teeth. 

Condylomata. 

Sores or pseudo-scars radiating from the corners of the 
mouth. 

Iritis. 

Choroidea areolaris. 

Affection of the bones, especially at the junction of 
epiphyses and diaphyses. 

A dusky, scaly eruption. 

Affection of the middle ear and eustachian tube. 

Affection of the auditory nerve. 

Gastrointestinal disturbances (vomiting, diarrhoea, colic, 
anorexia, and emaciation — not pathognomonic). 

Dactylitis. 

From the second to the fourth year condylomata may 
develop. These may be caused either by hereditary or 
acquired syphilis. Small, thin cicatrices on the nose, are usually 
due to hereditary syphilis. Hutchinson's teeth may be due 
to other causes of malnutrition, and sometimes are not present 
in syphilis. There is profound anemia and a yellowish 
complexion. 

In the second stage of hereditary syphilis, condyloma 



38 Diagnosis of Syphilis. 

and iritis are the most important single symptoms. Often 
a useful diagnostic tripod is formed by syphilitic rhinitis, 
sores or pseudo-scars radiating from the corners of the 
mouth, and the presence of a dusk}' scaly eruption. With 
the appearance of the teeth, a central crescent-shaped exca- 
vation in the permanent upper incisors denuded of enamel, 
is suggestive. However, notched teeth are not invariably due 
to syphilis. A choroidea areolaris is an important sign. 

The secondary and tertiary symptoms of hereditary syph- 
ilis are the same as those found in acquired syphilis. 

Syphilis tarda may be accompanied by a persistence of 
infantile testes with little or no pubic hair. The mammae 
may be small or infantile. The nose is often small and 
deformed. The lips present cicatrices. The hair is thick 
and dry. 

ACQUIRED SYPHILIS. 

Incubation. 

The period of incubation usually lasts from two to four 
weeks. Cases have been reported in which the incubation lasted 
only one week ; again, it has been reported as long as eight 
weeks. The length of the period of incubation is one of the 
most valuable points in diagnosis, but frequentty is not deter- 
minable because the patient's statement may be unreliable 
or misleading, and confrontation is rarely practicable. 

First Stage. 

At tins time the following is a valuable diagnostic tripod: 

(1) Period of incubation. 

(2) Induration of base of chancre, and 

(3) Adenopathy of nearest lymphatic glands. 

After the period of incubation, the beginning of the 
first stage of syphilis is announced by the appearance of the 
primary sore, ulcus durum, at the point of inoculation. The 



Diagnosis op Syphilis. 39 

initial lesion usually appears as a slightly red infiltration, with 
sharply defined borders, induration (hence the term "Hunter's 
induration") and slight sensitiveness. This lesion is sometimes 
referred to as the hard, syphilitic or Hunterian chancre. At 
times the infiltration is in the form of a nodule, the so-called 
initial papule or syphilitic papule. In size, the initial lesion 
varies from that of a pea to a quarter. Usually the indura- 
tion soon shows necrosis of its centre, to constitute an ulcer. 

The induration may be: (a) laminated, thinner and less 
distinct than — (b) parchment induration, in which the base 
of the ulcer feels like parchment. (c) Nodular induration, 
the base of the ulcer feeling like a nodule of cartilage or 
wood. This is the most characteristic, (d) Annular indura- 
tion, in which the margins of the chancre form an indurated 
ring. In such cases the center of the ulcer may remain normal 
in elasticity. 

Traces of induration may remain for years. Ricord 
observed induration that persisted ten and fifteen years after 
the primary infection. 

The location has much to do with the character of the 
induration. Upon the labia majora induration is more pro- 
nounced than upon the labia minora or the fourchette. < 

Induration may be entirely absent. 

As a rule the chancre has a peculiar cartilaginous feel 
that is almost characteristic. This varies somewhat with the 
tissue in which the primary sore occurs. Thus, primary 
infection of a cervix previously deformed by the formation 
of scar tissue in an old tear, may be confusing, so far as 
diagnosis by touch is concerned. But usually even in these 
cases no little aid in diagnosis is afforded by the sense of 
touch. The shape of the induration is usually circular, but 
varies with the part involved. Thus, a primary sore in the 
urethra may cause a tubular induration. 

Induration may be caused by other things, such as inflam- 
mation or the use of caustics, or may be masked or changed 
by inflammation or gangrene. 

Under proper treatment, the primary sore disappears in 



40 Diagnosis op Syphilis. 

four to six weeks. As a rule the induration does not persist 
longer than a month. When secondary infection has occurred, 
there may remain a simple thickening of the connective tissue. 
Sometimes the primary ulceration shows a serpiginous char- 
acter, believed by some observers to be due to gummatous 
changes. Or the ulcerative process may be greatly protracted 
by involvement of the lymphatics. 

The following are the more important diagnostic features of 

Chancre. 

1. Incubation one week to two months, usually about 
two weeks. 

2. Derived from a preceding case of syphilis by direct 
or indirect contagion. 

3. Begins as an indurated infiltration or nodule at the 
point of inoculation. 

■1. Necrosis of the center of the infiltration to form 
an ulcer ; rarely there may be no ulceration. The ulcer is 
usually superficial, without abrupt margins ; may be elevated. 

5. Cartilaginous or parchment induration of the base of 
the chancre. 

6. The shape of the infiltration is usually circular. 

7. Chancre is usually single ; multiple chancres may result 
from multiple inoculations received at or about the same 
time, before immunity is established. 

8. The secretion is scanty and serous ; does not cause 
auto-inoculation. 

9. The pain and discomfort is slight compared with the 
size of the lesion. 

10. Adenopathy : Indolent buboes usually appear in the 
neighboring lymphatics within two weeks after the appear- 
ance of the initial lesion. 

11. Duration: Disappears in a few weeks under proper 
treatment. 

12. Later appearance of the characteristic features of 
the second and third stages of syphilis: Syphilides and 
gummata. 



Diagnosis of Syphilis. 41 

13. May lead to the infection of others, producing 
syphilis. 

14. Responds to anti-syphilitic treatment : Mercury. 

15. Undergoes resolution to leave a scar or circumscribed 
loss of pigment when located upon the skin ; may leave no 
visible scar or change when located upon mucous membrane. 

16. The spirochete pallida is present, and may be most 
readily found in serum from the deeper parts of the chancre, 
such as may readily be obtained by scraping. When obtained 
in this way, the examination is easier, since the great bulk 
of the more superficial saprophytic spirochetes will be avoided. 

17. The Wassermann reaction is not present before the 
sixth week after infection. 

In diagnosis, it must be remembered that not all genital 
scars are due to syphilis. The use of caustics or the destruc- 
tion of tissue by septic infections or other non-syphilitic 
processes may leave scars. Upon mucous membrane, it is often 
impossible to detect any scar after the disappearance of 
the initial lesion of syphilis. Upon the skin, the site of the 
primary sore may be marked more or less permanently by a 
scar or by a circumscribed spot containing less pigment than 
the normal tissue. 

The primary sore is usually single, but may be multiple. 
As stated, the primary sore appears at the point of inoculation. 
Therefore, the initial lesion is most frequently found upon 
the genitals. But extra-genital infection is not uncommon. 
The most frequent extra-genital location of the^ primary sore 
is the mouth. The corners of the mouth and the tongue 
are favorite seats. The gums, tonsils and hard palate are less 
frequently involved. Occasional cases are found upon the 
breast, the face, especially the chin, nose, eyelids or con- 
junctiva; the ear, forehead; the arms, and upon the extremi- 
ties, the hands, fingers, and even the toes. 

In some cases the initial lesion may be either wholly want- 
ing or so slight as to escape observation. The presence of a 
chancre in hereditary syphilis would be a curiosity because of 
its rarity. 



42 Diagnosis op Syphilis. 

Sometimes the initial sore is accompanied by an indurated 
edema (oedema indurativum of Sigmund ; cedeme sclereux of 
Fournier). This may involve the penis, rarely extending to 
the scrotum; and in women it may affect the labia majora, 
the prepuce of the clitoris and more rarely the labia minora. 
In women the edema may be unilateral. 

In genital syphilis, the male usually shows primary involve- 
ment of the prepuce, glans or urethra. In the female the 
sore is usually on the inner side of the labia, or the clitoris, 
or on the vaginal portion of the cervix. Extra-genital chancre 
occurs most frequently at the anus, and more frequently in 
this locality in women than men. The lymphatics in the 
neighborhood of the primary sore are enlarged, and suppura- 
tion may occur both in the primary sore and in the adjacent 
lymphatics. 

The enlarged lymphatic glands, commonly known as indo- 
lent buboes (as distinguished from inflammatory or painful 
buboes), are usually to be found within two weeks after 
the initial lesion. Sometimes these enlargements appear at 
the same time or soon after the primary sore ; or they may be 
delayed, rarely longer than two weeks. One, more often 
several, buboes of varying size up to that of a walnut, appear 
and remain for months or } r ears. Suppuration of the primary 
sore or of the lymphatics may be caused by secondary 
infection. 

In genital syphilis, the lymphatic glands of the groin 
are most frequently enlarged, and as a rule, but not invariably, 
the enlargement of the glands is most marked upon the side 
of the primary sore. Other lymphatic glands may be enlarged, 
especially the femoral glands and the iliac glands. 

In extra-genital syphilis, in which the initial sore appears 
upon the fingers, nipple, lips, tongue, eyelids, etc., the en- 
larged lymphatic glands are found in the region of the 
elbow, axilla, neck, or the preauricular glands. The nearest 
lymphatics are sometimes apparently normal in size, the 
next series of glands being enlarged. Thus, in genital syphilis, 
the groin may be clear and the pelvic glands enlarged. 



Diagnosis of Syphilis. 43 

Adenopathy may be caused by other things, such as by 
inflammation of a sore, in which instance the glands are 
usually tender; the syphilitic bubo, too, may be painful 
in cases of mixed infection. 

Sometimes the affection of the lymphatic vessels may be 
detected, especially on the under side of the penis, in genital 
syphilis. This is the indurated lymphangitis of Lang. In 
the female, these lymphatics may sometimes be detected be- 
tween the labia and the glands of the groin. The affection 
of the lymphatic vessels usually does not persist so long as 
the affection of the lymphatic glands. Suppuration of the 
lymphatic vessels is rare. 

Chancre in hairy regions, such as the scalp or parts 
of the face covered by the beard or moustache, may resemble 
ecthyma. After shaving, such a chancre will be found 
glazed, flat or elevated. Later induration and lymphadenitis 
proclaim the syphilitic nature of the process. s When razor 
cuts heal and later reopen, syphilis should be suspected. 
Pseudo-furuncles, acneiform pustules, cracks around the nares, 
etc., when characterized by painlessness and persistence, the 
presence of bloody crusts and an areola of subinflammatory 
edema, require only the characteristic adenopathy to justify 
the diagnosis of chancre. 

Vaccino-syphilis has become rare since the adoption of 
bovine virus for vaccination. In such cases, the chancre 
appears after the vaccination has run its course. When 
a vaccine sore reopens or persists unduly long, and does not 
respond to antiseptic treatment, chancre should be suspected, 
especially if humanized lymph has been used for vaccination. 
The diagnosis is confirmed by induration and adenopathy. 

Mammary chancre, due to suckling a syphilitic child, ad- 
mits of confrontation as an aid to diagnosis more frequently 
than in any other class of cases. In suspicious cases, we 
should never fail to examine the child, if possible. 

Chancre of the tonsils and isthmus of the fauces is 
most frequent in women. In seven cases reported by 
Mackenzie, six were women. 



44 



Diagnosis op Syphilis. 



Upon the forearm, chancre is found most frequently upon 
the anterior surface. 

Upon the thigh, chancre occurs most frequently upon the 
anterior surface in men, and upon the posterior surface in 



CHANCROID. 

1. Due to inoculation from chan- 
croid ( ulcer, bubo or ljinphitis ) . 
Syphilitica are not exempt, so that 
both lesions often occur in the same 
patient. 

2. Incubation period of a num- 
ber of hours, usually not more than 
a day or two. 

3. Usually confined to the geni- 
tals; extra-genital chancroid is rare. 



4. Chancroid ulcer begins as a 
nodule, that forms a pustule and 
breaks down, to form a deep, pain- 
ful ulcer with an unclean base. 

5. May be single, but often are 
multiple, frequently as the result 
of auto-inoculation. The chancroid 
ulcers are often successively multi- 
ple. 

6. May be round or oval, but 
usually less symmetrical than chan- 
cre ; borders often described by seg- 
ments of large circles. 

7. The edges are clean cut, ir- 
regular, sometimes undermined, pre- 
senting a punched-out or crater- 
shaped appearance. 

S. The chancroid ulcer is rough 
and uneven, with reddened and swol- 
len edges and base, covered by a 
grayish pultaceous discharge. 

9. The secretion is abundant and 
purulent. 

10. Induration is the exception, 
and when present is caused by caus- 
tics or inflammation, and seldom 
feels like the induration of chancre. 

11. The chancroid ulcer is pain- 
ful. 

12. Chancroid ulcer runs an ir- 
regular course; phagedena are 
more common. Confers little or no 
immunity, so that second attacks 
are common. 



CHANCRE. 

1. Confrontation: Due to inocu- 
lation (direct or indirect) from a 
case of syphilis. Chancre, chancroid 
and gonorrhoea frequently co-exist. 

2. Incubation from one week to 
two months; usually two or three 
weeks. 

3. Appears at the point of inocu- 
lation — most frequently upon the 
genitals, less frequently upon the 
anus, mouth, face, breast, extremi- 
ties, etc. 

4. Chancre liegins as an indura- 
tion, that undergoes central necrosis 
to form an ulcer. Rarely remains 
a papule or tubercle without ulcera- 
tion. 

5. Almost always single. Occa- 
sionally multiple, due to multiple 
inoculations received at the time of 
exposure; rarely successively multi- 
ple. Auto-inoculation is almost un- 
known in chancre. 

6. Symmetrical in shape, usually 
round or oval. 



7. The ulcer is usually superfi- 
cial, a simple cup-shaped depression 
without abrupt margins; may be 
elevated. 

8. The surface of the ulcer is 
smooth, shining, red. glazed, often 
covered with a scab or a diphthe- 
ritic membrane. 

9. The secretion is scantv and 



10. The induration of the base, 
with its peculiar cartilaginous elas- 
ticity, is one of the principal diag- 
nostic characteristics of chancre. 

11. Chancre causes little or no 
pain. 

12. Chancre runs a fairly regu- 
lar course, and confers marked im- 
munity, so that second attacks are 
rare. 



Diagnosis op Syphilis. 45 

13. Affection of the lymphatic 13. Affection of the lymphatic 
glands occurs in about one-third glands is the rule in chancre, re- 
of the cases of chancroid; when af- suiting usually in indolent buboes, 
fected, the glands usually suppurate, Much more often multiple than in 
and the pus from them is infee- chancroid. 

tious. 

14. Affection of the lymphatic 14. Affection of the lymphatic 
vessels shows more inflammatory re- vessels causes little or no percepti- 
action than in chancre. ble inflammatory reaction. 

15. Chancroid is a more serious 15. Chancre tends to undergo res- 
local lesion, because of the greater olution, to be followed later by the 
persistence and destruction of tissue, general symptoms of syphilis. 

but it is not followed by general 
symptoms. 

16. Local treatment is curative. 16. Mercury is specific. 

17. Chancroid streptobacillus of 17. Spirochete pallida present. 
Ducrey.* Spirochete pallida absent. Possibility of mixed infection, 
except when syphilis is present. 

18. Wassermann reaction absent, 18. Wassermann reaction is not 
except when there is a co-existing present before the sixth week after 
syphilis. infection. 

Syphilis and the non-syphilitic venereal ulcer may co-exist. 
Not infrequently we are called upon to differentiate between 
these affections, especially when the lesion is located upon the 
genitals. Chancroid is comparatively rare extra-genitally, e. 
g., upon the lips or face. The ulcerated initial lesion of 
syphilis may bear some resemblance to the venereal ulcer. 
The primary sore of syphilis appears after an incubation 
of a number of days, usually about two weeks. The incu- 
bation of venereal ulcer is a matter of hours, as a rule a day 
or two. We have already referred to the appearance of the 
primary sore of syphilis. The ulcer of chancre is char- 
acterized by smooth edges, often elevated, sloping, adherent, 
and not undermined. The non-syphilitic venereal ulcer begins 
as a small nodule at the point of infection and rapidly be- 
comes a pustule. The breaking down of the pustule leaves 
an ulcer, deep and painful, with an unclean base. The edges 
are clean-cut, irregular, more perpendicular, and sometimes 



* Chancroid streptobacillus of Ducrey: Short, thick bacilli, with 
rounded ends and a slight constriction in the center. Usually found out- 
side the cells, sometimes within them. Stains readily with fuchsin or 
gentian violet; decolorized by Gram. 



46 Diagnosis of Syphilis. 

undermined. The secretion of chancre is scanty, serous or 
serosanguinolent, save when irritation or mixed infection 
causes it to become purulent ; the secretion of chancroid is 
copious, purulent, and irritating in the early stage, becoming 
laudable when the ulcer is healing. Auto-inoculation of the 
non-syphilitic venereal ulcer is common. Affection of the 
lymphatics usually does not follow, but when the lymphatic 
glands are involved they usually suppurate, and the pus 
from them is infectious. When the lymphatic vessels are 
involved, they show more inflammatory reaction, as a rule, 
than in syphilis. 

More rarely we are called upon to differentiate the initial 
sore of syphilis from a beginning carcinoma. In this con- 
nection, it must be remembered that cases have been observed 
in which carcinoma has developed upon the primary lesion 
of sj'philis. Such cases are rare. Epithelioma may resemble 
chancre somewhat, but usually may be readily distinguished 
by the more rapid development of chancre, the early aden- 
opathy, and the course of the affections. Doubtful cases 
justify excision of a piece of tissue for microscopic examina- 
tion. (See differential diagnosis between syphilis and cancer 
of the lips.) 

An ulcerating gumma may resemble chancre, but there is 
usually the history or evidence of the longer duration of the 
disease. The lesion begins as an indolent tumor or mass 
that slowly ulcerates and forms a deep suppurating ulcer. 
There is not the same induration of the base as in chancre, 
the borders are more soft and ragged, and there is little 
or no affection of the neighboring lymphatic glands. 

Simple abrasions that terminate in ulceration may bear 
some resemblance to chancre. They run a different course ; 
septic infection may lead to adenopathy, and there may be 
some induration, but not so marked as in the base of chancre. 
They are usually more irregular in shape than chancre. 

Herpes pro genitalis is usually a multiple lesion, consisting 
of several vesicles. The base of the vesicles is reddened, but 
not indurated as in chancre. Later the vesicles become pustules 
and rupture, to become covered with a scab. There may 






Diagnosis op Syphilis. 47 

be affection of one or more neighboring lymphatic glands, 
which become enlarged and are usually more tender than in 
chancre. Involution is more rapid than in chancre, taking 
only a few days at the most. The condition is due to fric- 
tion, irritation by discharges or secretions, cold or fever, or 
possibly a neurosis. Chancre sometimes appears as a herpeti- 
form lesion, but there is not so distinct grouping of the 
vesicles as in herpes, the base is more indurated, the borders 
more thickened, and there is more marked affection of the 
neighboring lymphatics in the form of indolent buboes. 

Second Stage. 

Usually in from six to twelve weeks the constitutional 
symptoms of the second stage of syphilis are observed.* 

Fever is usually present, probably due to the discharge 
of the diseased contents of the lymphatics into the blood. 
Sometimes fever is delayed or absent, possibly because the 
poisonous material is emptied into the circulation more grad- 
ually. As a rule the fever of invasion begins about seven or 
eight weeks after infection. This fever is sometimes known 
as the fever of syphilitic eruption, because the eruption on the 
skin and mucous membranes appears about this time. As a 
rule the fever appears without a chill, and is accompanied 
by headache, malaise, general depression and weakness, and 
rheumatoid pains. The appetite may be increased or decreased. 

The increase of temperature usually occurs in the afternoon 
or at night, reaching 104-5° F. or more in the evening, 
with morning remissions to near normal. The fever of 
invasion lasts from two to four days as a rule. The temper- 
ature begins to fall with the appearance of the eruption, 
the fever disappearing in a day or two. 

Frequently, during the course of syphilis, secondary infec- 
tions cause fever, usually of an irregular type. 



*Long incubation. — Simpson recently reported a case showing ten 
days for the first period of incubation and 132 days for the second period. 
That is, the" total length of time from inoculation to the beginning of the 
second stage of the disease was 142 days. (Quarterly Bulletin, North- 
western Medical School, December, 1909.) 



■18 Diagnosis of Syphilis. 

Anemia is one of the prominent symptoms in syphilis. 
Syphilitic anemia is often present at the very beginning of 
the second stage, when it is sometimes called syphilitic chlorosis, 
and is accompanied by symptoms of general weakness, the 
patient becoming easily tired and appearing pale. 

Leucocytosis or lymphatic anemia is often present, es- 
pecially in the presence of strumous lymphadenitis. At times 
the spleen is enlarged, giving the appearance of a leukaemia ; 
or there may be a true syphilitic leukaemia. 

In some cases, an actual pernicious anemia has been 
reported in syphilis. 

During the second stage of syphilis, the Wassermann 
reaction is present, and the spirochete pallida may be found 
in the various ulcerations and in the blood, especially when 
drawn from the eruptive spots. 

The cutaneous and mucous lesions of syphilis are more or 
less characteristic. The most prominent of these are the 
syphilitic macules, papules, and pustules ; the squamous syphil- 
ides, condylomata, and falling of the hair ; the mucous 
patches, stomatitis, and sore throat. 



Syphilides. 

Syphilides may be differentiated from non-syphilitic ma- 
cules, papules, nodules, pustules, ulcers (with scales and 
crusts) in many instances, chiefly by the course of the 
disease. Kaposi describes the syphilides as "sharply defined, 
dense and uniform (cellular) infiltrations of the papillary 
body and corium, that differ from one another only in 
size. These cells are not fitted to undergo permanent organi- 
zation (into connective tissue), but always undergo involu- 
tion and disappear either by absorption or purulent degenera- 
tion. The syphilitic infiltration of the skin always enlarges 
and disappears in the same direction, viz., centrifugally. 
Hence the peripheral parts are relatively the most recent 
and exhibit all the characteristics of the fresh infiltration. 



Diagnosis op Syphilis. 49 

The oldest parts are in the center and are the first to dis- 
appear." 

The two chief characteristics of the syphilides are hyper- 
emia and cellular infiltration. Hyperemia is found especially 
during the first two years of the disease. Some cellular infil- 
tration may be found during the early months of the disease, 
in the superficial layers of the skin, and later in the deeper 
layers. 

Syphilides occur as macules, papules, pustules, bulla?, and 
tubercles, and these lesions are modified by pigmentation, 
scaling, crusting, ulceration and cicatrization. 

As a rule the general symptoms are not marked during 
the second stage of syphilis. The syphilitic fever appears 
with the syphilitic roseola, as the most common general 
symptom of syphilis during the second stage. Sometimes a 
marked eruption is preceded by slight fever, loss of appetite, 
pains in the muscles and bones, and lateral headache. 

At the time of the eruption of syphilides, we may find: 

The initial lesion; or, if it has healed, the induration or 
scar, where the chancre existed. 

Induration of the glands in the region of the primary 
inoculation. 

Adenopathy in various parts of the body, especially the 
cervical and epitrochlear glands. 

Syphilitic alopecia. 

Mucous patches, especially about the anus, genitalia and 
mouth. 

Later in the second stage, especially after the first year, 
there may be: 

Pains in the bones. 

Bone lesions. 

Permanent alopecia. 

Cicatrices, and other symptoms of syphilis. 

The color of the syphilides varies greatly, depending 
upon the stage of the eruption and upon the complexion 



50 Diagnosis of Syphilis. 

and health or cachexia of the patient. At first the early 
eruptions are usually a pinkish red, fading later to a yellowish 
or reddish brown ; or the eruption may have this color at first. 
The papular eruptions are usually a brownish red, the so-called 
copper or raw ham color. In the presence of poor circulation, 
blood stasis, which is found especially' in the lower extremities, 
the color is often a bluish or dull liver red. In general, 
blondes show a brighter and redder color ; brunettes, brownish 
colors ; and in the presence of cachexia the color is more 
likely to be livid or bluish red. The pigmentation left 
varies from light brown to almost black. The brownish 
pigmentation of the syphilitic scars fades gradually, to leave 
later a white glistening scar. 

During the early stages of syphilis, especially during the 
first year, we frequently find a great variety of lesions; 
macules, papules, pustules, crusts and scabs occur frequently 
side by side or in different parts of the body at the same 
time. The multiplicity and variety of these lesions speaks 
for sj-philis, especially during the first j-ear. In later years 
these features are not so marked. 

An important factor in the diagnosis of syphilis is found 
in the method of evolution of the disease. The sequence of 
chancre, syphilides and gummata is well recognized. A new 
set of lesions often develops before the disappearance of a pre- 
ceding set. In general, the syphilitic eruptions develop more 
slowly than the simple inflammatory affections of the skin. 
Syphilitic lesions often remain for a long time, when the 
patient is not under specific treatment. 

The early eruptions of syphilis are usually rounded in 
form and tend to group in circular patches or curved lines. 
This is especially true of the small papular syphilides. The 
large papular and tubercular syphilides often show a circular 
or crescentic arrangement, due to the lesion clearing up in 
the center and spreading at the periphery. The earlier 
eruptions are usually more symmetrical and more widely and 
evenly distributed than the later manifestations of the disease. 

Usually syphilitic lesions are characterized by little or 



Diagnosis of Syphilis. 51 

no pain, or itching. Where the syphilides develop rapidly, 
as in the papular and pustular syphilides of the scalp and 
the genital mucous patches, there may be marked itching. 
And where there is more or less constant friction and irritation, 
as in lesions of the mouth and genitals, and sometimes ulcer 
of the leg, pain may be a prominent symptom. 

Falling of the hair may be caused by syphilitic involve- 
ment of the scalp and other hairy parts, or through disturb- 
ance of nutrition due to the syphilitic infection. There may 
be a defluvium capillorum or an alopecia, which may involve 
not only the scalp but also the eyebrows, eyelashes, and 
the hair of the axillas and pubes. Not infrequently falling 
of the hair in syphilitics is due to the ordinary seborrhcea 
sicca. Falling of the hair, except when due to the presence 
in the scalp of macular, papula or gummata, is of little 
value in the diagnosis of syphilis, save as a symptom fre- 
quently found in the infections and in depraved conditions 
of the general nutrition. 

Affections of the nails, notably onychia and paronychia 
syphilitica, are usually confined to single toes or fingers, but 
may be multiple. Palmar and plantar syphilides may be 
accompanied by dullness, discoloration, irregular deformities, 
splitting and splintering of the nails. 

The so-called mucous patches are really papular eruptions 
upon mucous membranes. These are most frequently lo- 
cated on the lips, cheeks, tongue (especially the border 
and tip), soft palate, the lingual and faucial tonsils, and 
the posterior wall of the pharynx. In the presence of 
cleanliness, the mucous patches disappear in from two to four 
weeks without leaving a trace. In the absence of cleanliness, 
more particularly when irritated by tobacco, decayed teeth, 
etc., they may persist for months, and frequently recur. 
Mucous patches may occur upon any mucous membrane. The 
affection of the mouth has been emphasized at this time, 
because stomatitis and sore throat are prominent symptoms 
of syphilis in the second stage. 

Affections of the eye are of diagnostic value during the 



52 Diagnosis of Syphilis. 

second stage of syphilis, especially iritis, keratitis, and affec- 
tions of the optic nerve. Sometimes affections of the ear 
assume importance in diagnosis at this time. Occasionally 
there is epididymitis and parotitis. 

The importance of examinations for the spirochete pallida, 
and the Wassermann reaction, during the second stage of 
syphilis, can not be overestimated. 

Third Stage. 

The more prominent symptoms of the third stage of syph- 
ilis are skin eruptions, gummatous growths in the viscera, 
and amyloid degeneration. The gumma is the characteristic 
lesion of the third or tertiary stage of syphilis. This stage 
of the disease is not preceded by prodromal or general symp- 
toms. The gummata differ markedly from the secondary 
lesions in that they are not regularly or symmetrically dis- 
tributed. Usually they seem to prefer one side of the body. 
They may appear first in the skin and mucous membranes, 
or in the joints, or in the viscera. At first the gummata 
may feel elastic to the touch ; later they are harder. They 
show a marked tendency to degeneration. The subcutaneous 
and submucous gummata tend to undergo mucoid degenera- 
tion ; those in the glandular organs, liver, testes, and in the 
brain or muscles, tend to undergo fatty degeneration. 

Gummata may appear as earl}' as four or five months 
or as late as two or three decades, most frequently three or 
four years after the primary infection. They seem to prefer 
the face, scalp, shoulders, neck, arms, thighs and legs ; but 
no part of the body is exempt. Clinically, there are four 
periods in the life of a gumma: Formation, softening, ulcera- 
tion and repair. Gummata vary in size from one to four 
or five centimeters, usually not exceeding two centimeters, in 
diameter. The name is derived from the peculiar rubbery 
elasticity of the tumors and their gummy contents. At first 
the overlying skin appears normal. During the period of 
softening, the gumma becomes doughy and there may be 



Diagnosis of Syphilis. 53 

fluctuation. The overlying skin becomes reddened, thinned, 
and finally ulceration occurs, to permit the gradual escape of 
the gumma through the perforation. Repair takes place by 
the deposition of granulation tissue, beginning in the bottom 
and gradually filling the cavity. The general shape of the 
cavity is rather conical, the apex of the cone being at the 
perforation, and the base in the deeper tissues at the bottom 
of the cavity. Cicatrization leads to more or less depression 
and adhesion to deeper structures, often binding skin and 
bone together. 

The spirochete pallida may be found in tertiary syphilis, 
but the examination is much more difficult in this stage than 
during the first and second stages of syphilis. 

The Wassermann reaction may be found in the third 
stage of syphilis. The reaction may be absent when the 
process is quiescent, or when the patient receives vigorous anti- 
syphilitic treatment. 



MANIFESTATIONS ON THE PART OF VARIOUS 
ORGANS. 

Skin and Mucous Membranes. 

We have already paid attention to the primary lesion, 
chancre. At this time we will consider especially the second 
stage of syphilis, as manifested by syphilides in the skin 
and mucous membrane. The more important syphilides are: 

1. Macular syphilide. 

2. Pigmentary syphilide. 

3. Papular syphilide. 

A. Dry papules. 

a. Lenticular papules. 

b. Giant papules. 

c. Miliary papules. 

B. Moist papules (condylomata). 



54 Diagnosis of Syphilis. 

4. Variations of the papular syphilide: 

a. Vesicular syphilide. 

b. Hemorrhagic syphilide. 

c. Squamous syphilide, and 

d. Pustular syphilide. 

We will take these up more in detail. 
Macular Syphilide. 

Syphilis cutanea maculosa, maculae syphilitica?, commonly 
known as the syphilitic roseola or erythema, may be the first 
objective symptom of the second stage of syphilis. This erup- 
tion appears about forty days after the initial lesion, sometimes 
later, and especially during the first year of syphilis. The 
appearance of this eruption is too well known to merit descrip- 
tion. The recognition of the syphilitic nature of the eruption 
is usually favored by the presence of the initial lesion and 
indolent buboes. The syphilitic roseola may resemble the 
roseola of some of the acute exanthemata, notably measles 
and rotheln. The acute exanthemata show high fever witli 
the eruption, or preceding the appearance of the exanthem ; 
and the eruption is usually most marked in the head and 
face, which are not favorite localities of the syphilitic roseola. 
Furthermore, there is usually a difference in the appearance 
of the eruptions. Usually an early recognition of the exan- 
themata is afforded by the appearance of the enanthem. A use- 
ful diagnostic point is the fact that cold makes the eruption 
plainer in syphilis, whereas similar non-syphilitic erythematous 
eruptions are blanched by cold. The macular syphilide seems 
to prefer the chest and abdomen, the upper extremities and 
neck, and is more prominent upon the flexor surfaces. It 
spares the back of the hands and the dorsal surfaces of the 
feet, and is rarely found upon the face. After a week or 
ten days the eruption fades, the evolution being hastened by 
mercury. Itching, pain and constitutional symptoms are 
slight or entirely absent. 



Diagnosis op Syphilis. 55 

At the time of the appearance of the macular syphilide, 
there may be concomitant symptoms of syphilis, such as evi- 
dence of the existence of the primary lesion, adenopathies, 
crusts and papules, especially upon the scalp, falling of the 
hair and eyebrows, mucous patches on the tongue, lips, fauces, 
and around the anus, and possibly the history of headache, 
and pains in the bones and muscles. 

The macular syphilide must be differentiated from : 

1. Measles, in which the eruption appears first upon the 
face and neck, and blanches upon exposure to cold ; there 
is catarrh, especially of the respiratory tract; cough, and a 
characteristic fever and enanthem. 

2. Rubella (Rtitheln, German measles, French measles), 
distinguished by its mildness, the absence or slightness of 
prodromata and fever, the enanthem, the diffuse, rose-red 
rash, and the enlargement of the cervical lymphatics early in 
the course of the disease. Prefers youth, from five to fif- 
teen years. 

3. Scarlet fever, in which the punctate hyperemia appears 
first upon the neck and chest, to involve later the extremities ; 
and there is a fairly characteristic fever and enanthem. 

4>. Drug eruptions. The use of mercury, internally -or 
externally, is sometimes followed by a bright red eruption. 
This eruption, however, is usually confined to certain spots 
and is accompanied by burning and itching, and an eruption 
of minute vesicles. 

A roseola balsamica sometimes follows the internal use of 
copaiba, cubebs, santal oil, and the various balsamic prepara- 
tions. The eruption in these cases is usually characterized 
by rounded or irregular bright spots separated by appar- 
ently normal skin. There is great burning, itching and the 
formation of extensive urticaria. There is often disturbance 
of the stomach. These eruptions usually seem to prefer the 
dorsum of the hands and feet and the regions of the joints. 
The drug eruptions disappear upon discontinuing the offend- 
ing drug. 



56 Diagnosis of Syphilis. 

5. Urticaria. This eruption is characterized by the 
formation of wheals, and the presence of marked itching. 
The period of evolution is short, the urticaria appearing 
and disappearing in a comparatively short time. 

6. Tinea versicolor. This eruption will rarely cause 
difficulty in diagnosis. It tends to spread peripherally, is 
usually fawn-colored and scaly and prefers the uncleanly. 
In case of doubt, the microscope will reveal the characteristic 
parasite in scrapings from the skin. 

7. The non-syphilitic eryihemata are rarely diffuse, change 
their form and shape, are of a brighter color, undergo a 
more rapid evolution, and do not give the history of syphilis. 

Erythema iris and annulare occur with special frequency 
upon the backs of the hands and feet, where we do not 
so often find the roseola of syphilis. The erythema disappears 
in about two weeks without treatment. 

8. Tinea circinata may be recognized by the presence 
of the trichophyton in the scales and hair. 

9. The fresh scars left by a recent attack of smallpox 
have been mistaken for the roseola of syphilis — a mistake 
that seems scarcely justifiable. 

10. The bluish maculae produced by pediculi pubis may 
be explained by finding the nits or the insect upon the pubes. 

11. Cutis marmorata livida and the various angioneurotic 
eruptions do not show the same course as syphilis. 

Pigmentary Syphilide. 

In some cases pigmentation assumes prominence, and this 
fact has led some writers to describe a pigmentary syphilide. 
The color of the pigmentation varies from a light yellowish 
brown to a dirty gray. It is not a common form of syphilide, 
and is found mostly in women, especially upon the sides of 
the neck, occasionally upon the face, forehead, and exceptionally 
upon the chest, trunk and thighs. It seems to affect the 
latter regions more frequently when it attacks males. The 
pigmentary syphilide is found most frequently during the first 



Diagnosis of Syphilis. 57 

year, though it may occur during the second year or even 
later. The pigmentation remains for months or years. At 
first the pigmentation is evenly distributed over the affected 
area, but later white spots appear and gradually increase 
in size until the pigmentation appears only in wavy lines, 
giving the appearance of a piece of lace with large uneven 
meshes. 

Differential diagnosis calls for separation from: 

1. Chloasma, usually found upon the face, which is 
rarely the seat of the pigmentary syphilide. 

2. Vitiligo and leucoderma, which are not so symmetrical 
as the pigmentary syphilide. 

3. Tinea versicolor, usually scaly and sometimes causes 
itching ; appears especially over the front of the chest and 
abdomen, regions that are not so often affected by the pig- 
mentary syphilide. Doubtful cases may be settled by the 
microscope. 

Papular Syphilide. 

A — The syphilitic papular eruption appears as 

(1) Dry papules, the usual form on the trunk and exten- 
sor surfaces of the extremities, may occur as — 

Lenticular papules, 
giant papules, and 
miliary eruption, lichen syphiliticus. 

(2) Moist papules, papulas humidae, condylomata, occur 
especially about the external genitals, the genitocrural fold, 
the perineum, anus, depression of the navel, the axilla?, beneath 
a pendulous breast, between the toes, the furrow of an ingrow- 
ing toenail, and in the external auditory canal in the pres- 
ence of moisture (otorrhcea), or in any part of the body 
that is kept moist and macerated. 

B — Variations of the papular syphilide: 

(1) Vesicular syphilide. 

(2) Hemorrhagic syphilide. 



58 Diagnosis of Syphilis. 

(3) Squamous syphilide, and 

(4) Pustular syphilide. 

A papular eruption rarely develops from the syphilitic 
macules. More frequently the papules follow a roseola. A 
slight fever may precede the papular eruption. The papules 
may be classified according to size, as small or miliary papular 
syphilides, and large or lenticular syphilides. The color of the 
papular eruption varies, at first reddish, later becoming more 
of a dark blue or brownish color ; or the papule may present 
little change in color from the surrounding parts. Depending 
chiefly upon the location of the eruption, the papules may be 
dry or moist. The dry papules, which occur mostly on the 
trunk and extensor surfaces of the extremities, undergo retro- 
grade changes and desquamation, to gradually disappear in 
a number of weeks, leaving sometimes a discoloration of the 
skin that fades in the course of a few weeks. Often these 
spots are marked by an absorption of pigment that may persist 
for months or years. The lenticular papules are the more 
frequent of the two forms of the papular eruption in 
syphilis. 

Small Acuminate Papules. 

Should be differentiated from: 

1. Scabies, which causes intense itching, presents a 
peculiar history, scratch marks, burrows ; and the insect may 
be demonstrated. 

2. Lichen planus is characterized by larger papules, which 
are umbilicated, more deeply pigmented, and itch intensely. 

3. Lichen pilaris has pale papules, not arranged in 
groups, located over a hair follicle, and with greater tendency 
to scale. 

4. Lichen scrofulosum is comparatively rare and prefers 
childhood ; characterized by pale yellow papules, that disappear 
without marked pigmentation ; usually confined to the trunk. 

5. Punctate psoriasis is more scaly than this form of 
syphilide ; spreads from the periphery, and bleeding may be 



Diagnosis op Syphilis. 59 

caused by scratching. Psoriasis frequently involves the scalp 
and is found over the knees and elbows. The spots are large, 
covered with dense white scales. 

Larger papules, from the size of a pea to that of a 
bean, the so-called giant papules, are regarded as an unfavor- 
able early eruption. 

Still more unfavorable, from the standpoint of prognosis, 
is the small or miliary syphilitic eruption, the lichen syphil- 
iticus. These small papules usually persist longer than the 
lenticular papules. And it is the rule for them to leave a 
scar. The papular syphilide may show many variations, e. g., 
vesicular, hemorrhagic, squamous and pustular syphilides. 

A papular eruption on the palmar surfaces of the hands 
and the plantar surfaces of the feet is sometimes one of the 
early symptoms of the second stage of syphilis. These surfaces 
usually present a circumscribed erythema and flat infiltrations, 
rather than raised papules. Later, desquamation is prominent 
over these surfaces. As a rule, this eruption is bilateral, affect- 
ing both hands, or both feet, or both hands and feet. The 
papular eruption in these localities runs a slow course, con- 
stituting the affection known as psoriasis palmaris or plantaris. 
Not infrequently the flexor surfaces and the nails are involved, 
and the rhagades and fissures are painful. Islolated papules 
in thickly calloused parts may present striking appearances ; 
on the feet these may at times resemble a beginning perforat- 
ing ulcer. 

Moist papules, papula? humida?, occur especially about 
the external genitals, the genitocrural folds, the perineum, 
anus, the depression of the navel, the axilla?, beneath a pendu- 
lous breast, between the toes, in the furrow of an ingrowing 
toenail, in the external auditory canal in the presence of 
otorrhoea, or in any part of the body that is kept moist and 
macerated. These papules attain a larger size, as a rule, 
than the dry papules, sometimes reaching the size of a silver 
dime, or larger. The fact that these papules are broad 
and flat has led to the term condylomata lata. Often these 
papules, through maceration, secrete considerable pus, which 



60 Diagnosis of Syphilis. 

led the older writers to refer to them as pustula foeda. Not 
infrequently the flat papules coalesce, e. g., in condylomata 
of the anus, so that the diagnosis is based largely upon the 
examination of the finger-like projections. Breaking down of 
the moist papule ma} 1 occur, to constitute the ulcerated papule 
or syphilitic ulcer. 

Squamous Syphilide. 

Should be differentiated from: 

1. Tinea circinata. 

2. Psoriasis vulgaris. 

3. Lichen rubor planus, 
-i. Eczema. 

5. Molluscum contagiosum. 

6. Arsenical keratosis. 

7. Tyloma, the ordinary callus. 

8. Venereal papillomata. 

These affections would not present the spirochete pallida 
nor the Wassermann reaction, except in the presence of a 
concomitant syphilitic infection. 

1. The squamous syphilide may resemble somewhat tinea 
circinata or a patch of psoriasis. In a case of doubt, micro- 
scopic examination would reveal mycelia in tinea. It is rare 
that any confusion will arise between ringworm and syphilis. 
Psoriasis is more often puzzling. Psoriasis vulgaris more 
frequently affects the scalp and the extensor surfaces of the 
extremities, less frequently the palmar and plantar surfaces, 
when the affection has become general. 

2. In psoriasis vulgaris the scales are broadly lamellated 
and frequently heaped up, contrasting with the fine lamellation 
of the papular syphilide. Furthermore, in syphilis pigmenta- 
tion is the rule; in psoriasis vulgaris pigmentation is infre- 
quent. In the rare cases of a spot or spots of psoriasis vulgaris 
on the genitals, the dry, smooth surface and gleaming redness 
of the eruption are quite different from the appearance of the 
syphilitic eruption. 



Diagnosis of Syphilis. 61 

3. Lichen rubor planus, especially of the genitals, may 
be confusing. This eruption is composed of small, tough, 
waxy, shining nodules with a central depression, arranged in 
groups; there is itching in many cases that is often intense; 
and the eruption persists for a long time. After disappearance 
of the nodules, there may be a bluish patch of pigmentation 
left, that is not infrequently adjoined or surrounded by another 
crop of the nodules. Desquamation is slight, vesicles and 
pustules do not form, and any ulceration is the result of acci- 
dent. Lichen is exceptionally found upon mucous membranes. 

4. Not infrequently patients come to us with an eczema, 
especialty of the palms, under the impression that it is a 
palmar syphilide. There is some resemblance when the eczema 
is desquamating. But eczema is characterized by itching, and 
observation for a few days will reveal the formation of little 
millet-seed vesicles. 

5. Molluscum cotagiosum presents a firm, slightly umbili- 
cated, shining yellowish nodule, with creamy contents. 

6. Arsenical keratosis and 

7. The ordinary callus, tyloma, need only be mentioned. 

8. Venereal papillomata are not syphilitic, but may 
conceal syphilitic papules, in the presence of which they have 
a tendency to grow luxuriantly. 

Tubercular Syphilide. 

Differentiate from: 

1. Large papular syphilide appears earlier and undergoes 
evolution more rapidly ; retrogresses differently, flattens and 
desquamates, or may desquamate repeatedly. On the other 
hand, the tubercular syphilide shows a distinct tendency to 
remain globular in shape, does not erode, and undergoes reso- 
lution to leave pigmentation. 

2. Palmar psoriasis is usually found associated with psori- 
asis in other parts of the body. True psoriasis is rare on the 
palms. 

3. Palmar eczema presents scaling, Assuring, burning and 



62 Diagnosis of Syphilis. 

itching, and a serous exudation. Eczema tends to extend 
beyond the palms, and the edges of eczematous patches are not 
so well defined as in the tubercular syphilide. 

4. Lupus vulgaris, especially of the face, may be confus- 
ing. Both affections may occur in the same localities ; both may 
undergo interstitial atrophy and disappear without ulceration ; 
both may extend at the edges to run a serpiginous course. 
Lupus usually appears before puberty and runs a slower 
course than the tubercular syphilide. As to color, lupus is 
more of a pink color, the outlines are not so well defined, 
and the inflammation about the tubercles shades off gradually. 
In lupus the ulcers are not so painful and bleed easily, and 
the secretions and crusts are less abundant. Lupus heals 
more slowly, and the scars are puckered, thick and hard, differ- 
ing from the smooth, sliining and often depressed scars of 
syphilis. In some locations the differential diagnosis is very 
difficult in some cases, for instance, upon the nose. Lupus 
usually begins on the outside, whereas syphilis may begin 
in the bone; lupus may destroy the cartilage, but rarely 
attacks the bone, whereas syphilis often shows a distinct pref- 
erence for the bone. Syphilis is more prone to be accom- 
panied by ozena. 

5. Acne rosacea tuberosa shows less clearly defined nodules, 
situated in an area of thickened and reddened epidermis among 
dilated capillaries, and does not present the destructive changes 
of sj'philis. The syphilitic lesions are smoother, more glassy, 
firm and clearly marked in outline. 

6. Epithelioma is usually single, the edges are hard and 
everted, the base is often granulating and fungous, the disease 
prefers the aged, and is accompanied by adenopathy and 
cachexia. 

7. Tubercular leprosy, especially upon the forehead, face 
and ears, may resemble syphilis. The leprosy tubercles usually 
show a distinct anesthesia of the center, extending often over 
a small area around it. The tubercular syphilides are not so 
large and protuberant, and are harder. 



Diagnosis of Syphilis. 



63 



Tubercular Syphilide. 

1. Occurs after puberty. 

2. The lesions are opaque, of a 
deep brownish red color. 

3. Ulceration occurs within a 
month or two, the ulcers hieing 
usually distinct, deep, circular, with 
perpendicular edges. 

4. The secretion is abundant, 
often offensive. Large greenish 
crusts. 

5. The scars are smooth, shining, 
often depressed, soft, white, circular. 

6. The tubercles are distinctly 
circumscribed. 

7. More painful and less inclined 
to bleed than lupus. 

8. History and further evidence 
of syphilis may aid in diagnosis. 

9. Anti-syphilitic treatment spe- 
cific. Local treatment of compara- 
tively little value. 

10. Upon the nose, syphilis usu- 
ally begins in the bone, and shows 
a distinct preference for bone. More 
prone to cause ozena. 

11. Spirochete pallida may be 
found. 

12. Wassermann reaction pres- 
ent. 



Lupus Vulgaris. 

1. Usually begins before puberty. 

2. More translucent and of a 
pink color, with outlines not so well 
defined. 

3. Ulcers develop more slowly, 
requiring several months or longer, 
and the ulcers are more often con- 
fluent, shallow, irregular in form. 

4. Slight inoffensive secretion. 
Thin, dark colored crusts. 

5. The scars are puckered, dis- 
torted, irregular, thick and hard. 

6. The inflammation about the 
lupus nodules shades off gradually. 

7. The ulcers are not so painful 
and bleed easily. 

8. It should be remembered that 
syphilitics are not exempt from 
lupus. 

9. Tuberculin specific. Local 
treatment important. 

10. Lupus usually begins on the 
skin, may destroy the cartilage, but 
rarely attacks the bone. 

11. Spirochete pallida absent, 
except in the presence of syphilis. 

12. Wassermann reaction absent, 
except when there is a co-existing 
syphilis. 



Pustular Syphilide. 

Should be differentiated from: 

Smallpox. 

Acne vulgaris. 

Acne frontalis seu varioliformis (F. Hebra). 

Acne necrotica (C. Bceck). 

Acne cachecticorum. 

These affections do not show the spirochete pallida, nor 
the Wassermann reaction, except when they occur in syphilitics. 

Pustular syphilides result from infection of the papular 
syphilides by the ordinary pyogenic micro-organisms. In 
all these cases I have examined, the staphylococcus pyogenes 
aureus was the organism of secondary infection. The staphyl- 
ococcus pyogenes albus has also been reported. 



64 Diagnosis op Syphilis. 

The pustular syphilitic eruption may resemble smallpox. 
Both diseases have an eruptive fever, which is, however, 
usually more intense in smallpox. Usually the diagnosis is 
made through associated symptoms. The occurrence of small- 
pox in a syphilitic patient may be intensely interesting. 

Acne vulgaris may at times resemble acne syphilitica, 
but the two affections run entirely different courses. More 
difficult to differentiate is acne frontalis seu varioliformis 
(F. Hebra) and acne necrotica (C. Baeck). These are re- 
garded by some as identical or related forms of acne. They 
may persist for a long time and leave scars. Differential diag- 
nosis often must rest upon accompanying symptoms. Acne 
cachecticorum is often accompanied by other symptoms, es- 
pecially caries of the bones and joints, multiple adenitis, 
and other symptoms of a depraved constitution, which may 
be found in grave cases of syphilis. Furthermore, this acne 
may occur in a patient that has or has had syphilis. In 
such cases the differential diagnosis will depend upon con- 
comitant symptoms and the result of treatment. 

Pemphigus serpiginosus may at times resemble rupia syph- 
ilitica, but the former does not show the same ulceration and 
maceration of the skin that we have in syphilis. The ulcer 
may closely resemble the gummatous ulcer. 

Yaws. 

Many observers believe yaws to be a form of syphilis, 
modified by race and climate. The spirochete pertensis, be- 
lieved to be the cause of yaws, bears a marked resemblance to 
the spirochete pallida, of syphilis. Silver stained specimens 
can scarcely be distinguished. In yaws, the spirochetes are 
found most abundantly in the superficial layers of the lesion, 
especially in the fibrinous crust among the leucocytes and the 
degenerated epitheliub, less abundantly in the spithelium about 
the ulceration, and only rarely in the papilla. In the pri- 
mary sore of syphilis, the spirochete pallida seems to prefer 
the connective tissue and the neighborhood of blood vessels. 



Diagnosis op Syphilis. 65 

In the initial lesion of yaws, the epithelium shows greater 
hypertrophy than in chancre. Polymorphonuclear leucocytes 
are found in greater abundance in the lesion of yaws ; the 
plasma cells are more generally distributed and do not show 
the vascular distribution noted in syphilis. There are fibrinous 
exudates in yaws, and few or none of the vascular changes, 
save a simple dilatation. 

SYPHILITIC AFFECTIONS OF THE DIGESTIVE 
ORGANS. 

Mouth, Including Tongue and Tonsils. 

The initial lesion occurs, in the order of frequency, upon 
the lower lip, the upper lip, the tongue, the mucous membrane 
of the buccal cavities, the palatal arches, and the tonsils. 
The neighboring lymphatic glands, especially the submental 
and submaxillary glands, later the superficial and deep glands 
of the neck and nucha, are extremely enlarged, compared with 
the size of the lesion. The glands are firm, whereas tubercu- 
lous glands often show some softening. The glands are usually 
indolent buboes, although at times sensitive patients complain 
of some discomfort from them. Especially when located upon 
the lips or tongue, the primary sore may markedly interfere 
with speech, mastication and deglutition. Even in these cases 
the pain is usually not great ; there is a disagreeable tension 
rather than pain. Still less disturbance of function may be 
caused by a primary lesion upon the arches of the palate or 
the tonsils, unless the lesion is large, when deglutition is inter- 
fered with and speech becomes palatal and nasal in character. 

Oral chancre should be differentiated especially from: 

1. Chancroid and cancer. 

2. Lingual chancre may resemble: — 

3. Cancer. ' 

4. Parenchymatous glossitis. 

5. Tuberculous ulcer, or traumatic ulcer. 



66 Diagnosis of Syphilis. 

Mucous Patches. 

These must be diffentiated from: 

1. Trauma. 

2. Cauterization, use of strong gargles, etc. 

3. Simple catarrhal angina (after the patch sheds the 
whitish coat). 

4. Leucomata. 

5. Aphtha. 

6. Simple rashes. 

7. Warty growths (especially upon the tongue). 

8. Lingua geographica. 

9. Diphtheria. 

Gummata. 

Should be differentiated from: 

1. Cancer. 

2. Tuberculosis. 

3. Chancre. 

4. Leucoplakia and 

5. Decubital glossitis. 

It is not always easy to differentiate the primary sore 
of syphilis in the mouth from chancroid, since the induration 
of the base of the ulcer may be absent, especially in old and 
decrepit patients. Usually chancroid shows multiple lesions, 
whereas the primary lesion of syphilis is usually single. The 
lymphatics are usually painful in chancroid and more fre- 
quently suppurate than in syphilis. Further, the primary 
sore is sooner or later followed by the secondary symptoms of 
syphilis. Especially upon the lips, at the junction of the 
skin and mucous membrane, the initial sore presents an irregu- 
lar appearance, partaking both of the nature of the lesion 
in the skin and in the mucous membrane. In such cases it 
may be important to make a differential diagnosis from cancer. 
Such a differentiation may also become important in an initial 



Diagnosis of Syphilis. 



67 



lesion of the palate or tonsillar region, when the advisability 
of pharangotomy would be discussed in the case of cancer. 
Mikulicz and Kiimmel mention such a case that terminated 
fatally. 

Upon the tongue, the primary sore is most frequently 
located upon the anterior part of the dorsum, less commonly 
on the tip, sides, or underneath. Two forms may be distin- 
guished, the smooth and the ulcerated. Less common are 
the fissured sores, found especially in smokers. Sometimes 
there is marked induration resembling cancer or parenchyma- 
tous glossitis. Usually the glands upon the same side are 
most involved ; rarely the glands upon the opposite side are 
most affected. However, these variations in the affections of 
the lymphatics are due to their anastomoses, and may be 
observed in other diseases, notably in cancer. The rapid 
appearance of the sore, the induration, the enlargement of the 
lymphatics, and the secondary symptoms of syphilis, especially 
the rash, are usually sufficient for diagnosis. Before the 
appearance of the secondary symptoms, syphilis of the tongue 
may be mistaken for a traumatic or a tuberculous ulcer. 



LIPS. 



Chancre. 

1. There may be the history of 
exposure to syphilis. 

2. Odor not marked. 

3. May involve either lip. 

4. Affects either sex. 

5. Any age, but occurs especially 
during adolescence. 

6. General health may be good. 

7. The lesion is characterized by 
little or no pain. 

8. Chancre usually presents a 
regular outline, smooth surface, and 
the base is sharply circumscribed 
and presents the characteristic car- 
tilaginous feel. 



Epithelioma. 

1. No such history necessary. 
There is frequently the history of 
exposure to cancer. 

2. Odor offensive; may be less 
marked under proper treatment. 

3. Usually upon lower lip. 

4. Distinct preference for males. 

5. Rare before middle life. 

6. General health usually im- 
paired. 

7. The patient usually complains 
of pain, which may be sharp, burn- 
ing, or lancinating. 

8. Epithelioma is irregular in 
outline, usually ragged and bleeds 
easily, and the base is less circum- 
scribed, more extensive, and does 
not feel so cartilaginous as in chan- 
cre. 



68 



Diagnosis of Syphilis. 



0. Chancre develops in a number 
of days or weeks. 

10. The neighboring lymphatic 
glands are involved early. 



11. Mercury hastens the disap- 
pearance of chancre. 

12. Microscopic examination of 
the secretion may reveal the spiro- 
cheta pallida. The microscopic ex- 
amination of a section of tissue 
shows the structure of chancre, that 
is not pathognomonic, but differs 
markedly from epithelioma. 

13. Spirochete pallida present. 



14. Wassermann reaction not 
present before the sixth week after 
infection. 



0. Epithelioma may develop rap- 
idly, but usually requires months. 

10. The neighboring lymphatic 
glands are usually not enlarged un- 
til after the first three or four 
months, or longer. 

11. Mercury does not benefit 
epithelioma; may be deleterious. 

12. Microscopic examination re- 
veals endocytes and the character- 
istic cancer pegs and nests. There 
is a distinct ingrowing of the epi- 
thelial cells. 



13. Spirochetes have been ob- 
served, but not the spirochete pal- 
lida.* 

14. Wassermann reaction absent, 
except when there is a concomitant 
syphilis. 



* Spirochetes have been found in ulcerating carcinoma, but they dif- 
fer from the spirochete pallida found in syphilitic lesions. (Vorkom- 
men von Spirochivten bei ulcerierten Carcinomen, E. Hoffmann, Berliner 
klinische Wochenschrift, xlii, Xo. 27.) 



Among the most characteristic secondary lesions are the 
mucous patches (plaques opalines, plaques nuiqueuses, or broad 
condylomata). These have been described as resembling spots 
produced by touching with the stick nitrate of silver. Usually 
they are more delicate than this description would indicate. 
The whitish coating of the patches may not be detached with- 
out causing bleeding. The base is reddened and swollen. 
In size the patches may exceed that of a quarter; but they do 
not seem to enlarge while under observation, as a rule. In 
general, the largest patches are upon the tonsils and palatal 
arches, next at the angles of the mouth, and usually smaller 
upon the mucous membrane of the cheek and lips and the 
edges of the tongue, and still smaller on the surface of the 
tongue, the floor of the mouth, and the alveolar processes, 
and smallest at the base of the tongue, where they may occur 
in miliary patches. This also represents approximately the 
order of frequency, the tonsils, palatal arches and the uvula 
being most frequently affected. The patient may complain 
of no symptoms ; or there may be more or less burning during 



Diagnosis of Syphilis. .69 

deglutition, or interference with speech, especially when the 
tongue is involved. 

Especially when the ulcers present an atypical appear- 
ance, they may resemble the simple ulcers due to pressure. 
But there is not the characteristic induration. Further- 
more, the history would be of value, which would probably 
be sufficient to rule out trauma or cauterization and the use 
of strong gargles, etc., that might produce similar appear- 
ances. Later, with the disappearance of the whitish coating, 
the ulcer may resemble a simple catarrhal angina. In all 
of these cases, it is important to remember that enlargement 
of the lymphatics would speak for syphilis. The metastases 
cause disturbance that is slight in proportion to the size 
of the glandular masses. In doubtful cases, the therapeutic 
test may be made. Anti-syphilitic treatment may make the 
diagnosis more difficult for a time, since the patches at first 
may continue to develop and become thicker, more ragged and 
lardaceous. It must be remembered that the mucous patches 
occur in secondary and in hereditary syphilis. No age is 
exempt. Mercurial ulcers depend upon the use of the drug. 

Of more importance is the differentiation from leucomata, 
aphthae, and rashes and warty growths (especially upon the 
tongue). The whitish mucous patches are not so trans- 
parent as the bluish-white patch of leucoma. Upon the tongue, 
the mucous patches occur especially upon the borders ; leucoma 
prefers the dorsum. Ulceration is more marked in mucous 
patches than in leucoma. The thick, raised, leucomas, which 
most resemble mucous patches, are usually harder and dryer. 
Furthermore, leucoma usually runs a much more protracted 
course than the mucous patches. 

The presence of other symptoms of syphilis may make the 
diagnosis, or hinder it, in cases of leucoma occurring in asso- 
ciation with syphilis. Aphtha also presents white patches. 
Aphtha occurs in children and the debilitated ; syphilis more 
frequently in adults and those who are not in bad health. In 
syphilis there may be other symptoms of the disease. Doubt- 
ful cases may be cleared up by the use of the microscope. 



70 



Diagnosis of Syphilis. 



Lingua geographica will rarely be confused with mucous 
patches. The general gray color of the tubercle and its 
greater elevation above the surrounding tissue, are charac- 
teristic. Diphtheria may be definitely ruled out by making 
a culture, and the presence of the fever and general symp- 
toms of that disease. The presence of the ordinary warts in 
the mouth, especially upon the tongue, may at times be 
confusing. These are more common on the dorsum of the 
tongue, and are not affected by antisyphilitic treatment. The 
therapeutic test would not be thought of, save in the pres- 
ence of other symptoms of syphilis, which may make the 
diagnosis. 

In the third stage of syphilis, the tertiary lesions of the 
mouth involve especially the hard palate, the soft palate, 
and the tongue. This is the stage of gummata. Syphiloma 
of the hard palate usually occurs at the thinnest part of the 
bone, as a rule near the median line, and frequently causes 
perforation. The process of perforation may require weeks 
or months. Usually a sequestrum is thrown off before heal- 
ing occurs. The throwing off of the diseased bone is a slow 
process, requiring two months or longer under good treat- 
ment. A syphiloma upon the gums or alveolar process may 
ulcerate and cause the formation of a sequestrum. Even 
small perforations of the hard palate cause considerable 
difficulty, since fluid and food escape through the nose, 
and air passing through the perforation may affect the 
speech. Sometimes it is possible to prevent perforation of a 
gumma of the hard palate by instituting energetic anti-syph- 
ilitic treatment. 

Gumma of the soft palate rarely comes under observation 
before ulceration. Differing from gumma of the hard palate, 
in which a single gumma is the rule, in the soft palate the 
gummata are more often multiple, being scattered over both 
palatal arches or tonsils and frequently involving the base 
of the uvula, causing considerable deformity of the pharynx 
and the nasopharyngeal space. The gummata are often 
large in this region, and the inflammatory sj'mptoms are 



Diagnosis of Syphilis. 71 

often pronounced. Often there is great destruction of tissue, 
and not infrequently there is perforation of the soft palate. 
Later, with cicatrization, there is great deformity. From 
this description of gumma of the soft palate, it must be 
evident that there is marked interference with speech in these 
cases. This is often an early symptom. The infiltration 
of the soft palate causes nasal speech, and also permits the 
regurgitation of food, more especially of fluid, into the 
nasopharyngeal space during deglutition. 

Tertiary Syphilis of the Tongue. 

Tertiary sclerosing glossitis may be superficial (cortical), 
or deep (parenchymatous), or generalized (syphilitic macrog- 
lossia). Should be differentiated from: 

1. Indurated chancre. 

2. Psoriasis. 

3. Smokers' tongue. 

4. Dental glossitis. 

5. Epithelioma of the tongue. 

Tertiary syphilis of the tongue also appears as : 

(a) Syphilitic atrophy of the lymph gland follicles at the 
base of the tongue, behind the lingual V. 

(b) Nodes and nodules of various size, the result of the 
contraction of old syphilitic lesions. 

(c) True gummata of the tongue, superficial or deep. 

Deep gummata of the tongue must be differentiated from: 

1. Fatty tumors. 

2. Fibrous tumors. 

3. Carcinoma. 

4. Chronic abscess. 

5. Embedded foreign body. 

More rarely the tertiary lesions involve the tongue. 
A preference is shown for males. The affection known as 
syphilitic plaques and sclerosing glossitis, is probably more 



72 Diagnosis op Syphilis. 

common than the reported cases would indicate. Fournier 
states that the tertiary plaques precede and cause the deep 
fissures and furrows not infrequently observed in old syphilitics. 
Tertiary sclerosing glossitis may be superficial (cortical), or 
deep (parenchymatous). Superficial sclerosing glossitis is a 
superficial induration in the derma of the mucous membrane. 
These plaques may be single, islolated, multiple or confluent. 
Usually the spots are not painful. The affection is chronic, 
and finally leaves white patches. The so-called deep or paren- 
chymatous scleroses are usually both deep and superficial, 
though they may be limited to the deeper parts. At first 
they cause swelling on the dorsum of the tongue, which later 
atrophies. The lobulation of the dorsum of the tongue in 
these cases has been compared to the liver in cirrhosis. This 
mammilated, lobulated appearance of the tongue is quite char- 
acteristic. Usually the dorsum is the part affected, but the 
borders are not exempt. Deep induration may resemble 
cancer. The mucous membrane becomes wine-red and smooth. 
Erosion and ulceration of the furrows and fissures may occur. 
In generalized sclerosing glossitis, which is comparatively rare, 
the tongue is swollen and hard, constituting the so-called 
syphilitic macroglossia. 

The sclerosing inflammations of the tongue are chronic, 
and untreated they tend to break down and ulcerate, though 
the ulcers are rarely deep nor difficult to heal. The lymphatic 
glands are usually not involved, save possibly in the presence 
of inflamed and ulcerated plaques. Sclerotic glossitis is not 
likely to be mistaken for indurated chancre, psoriasis, smoker's 
tongue, dental glossitis, nor epithelioma of the tongue. Should 
any of these affections be resembled, the presence of other 
signs of syphilis will be of aid in making a diagnosis of that 
disease, though these various affections and syphilis may 
co-exist. In cases of doubt, the therapeutic test is justifiable. 

Syphilitic atrophy of the lymphatic gland folicles of the 
base of the tongue, behind the lingual V, was described by 
Virchow, 1863. The epithelium is apparently normal in these 
cases and there is no small-cell infiltration. 



Diagnosis op Syphilis. 73 

Nodes and nodules may appear as lumps of various sizes 
and shapes, produced by the contraction of old syphilitic 
lesions ; or there may be true gummata. 

Gummata of the tongue may be superficial or deep 
(parenchymatous). Males are most frequently affected, usu- 
ally four or five years after the first stage of the disease. 

Superficial gummata of the tongue appear especially upon 
the dorsum, rather than the tip or sides, forming nodes and 
nodules the size of a pin-head to that of a pea, in the mucous 
and submucous tissue. To the touch, they are often not well 
defined from the adjacent tissue. At first they usually cause 
no pain and may be unrecognized for a long time. In the 
papillary region, the overlying mucous membrane may be 
papillated. When the gumma extends towards or above 
the surface, the overlying mucous membrane becomes smooth, 
at first natural in color, later reddened. Gummata of the 
tongue are usually multiple, but not invariably. With the 
breaking down of the gummata, ulcers are formed. The 
depth of the resulting ulcer depends upon the size of the 
gumma and how deep it is located. Superficial gummata 
cause a relatively larger destruction of mucous membrane, 
when they ulcerate, than the deeper gummata. In diagnosis, 
it is well to remember that the gummata are often located 
in parts that are not subjected to irritation. Irregular forms, 
such as a superficial gumma of the edge of the tongue, may 
resemble other affections. Associated symptoms of syphilis, 
the use of the therapeutic test, and the microscopic exami- 
nation of a particle of the growth, make the diagnosis. 

Deep or parenchymatous gummata of the tongue are 
more difficult to diagnosticate. They may occur anywhere 
in the muscular part of the tongue, but tend towards the 
dorsum. Men in middle life are most frequently affected ; 
but they may appear in women, and even in children in con- 
genital syphilis. Cases have been reported in infants. They 
vary in size from masses imperceptible to the touch to tumors 
the size of a walnut or even larger, though the larger masses 
are usually caused by the conglomoration of a number of 



74 Diagnosis of Syphilis. 

gummata. In practice, the masses seen are usually larger 
than those observed in the superficial variety. They usually 
do not cause pain, and are not tender. They are possibly 
more frequently multiple than single. They tend to ulcerate, 
but this process may be delayed several months or even years. 
They have been reported (Fairlie Clark) to become calcareous 
and remain quiescent, but such cases must be exceedingly 
rare. The deep gummata not infrequently give the sense of 
fluctuation upon palpation. The tongue may be greatly 
swollen, especially when the mass approaches near the surface 
and is about to break down. An appearance resembling 
macroglossia may be caused, more especially by multiple 
gummata, but is not common. 

Deep gummata must be differentiated especially from 
fatty and fibrous tumors and carcinoma. The simple tumors 
are often polypoid, and usually they are more clearly defined, 
elastic, and more easily separated from the adjacent tissue. 
On the other hand, gummata are not sharply defined from the 
adjacent tissue, and they are more frequently indolent and 
inelastic. 

Innocent tumors are more often single and sometimes lob- 
ulated; gummata are more frequently multiple, and may 
seem to be lobulated only when close together. As com- 
pared with gumma, cancer is more often single, shows a pref- 
erence for the side of the tongue, and frequently is located 
near some source of irritation, such as a carious tooth. 
Furthermore, cancer appears more frequently after forty ; 
gumma between twenty-five and thirty-five years of age. 



Diagnosis op Syphilis. 



75 



THE TONGUE. 



Epithelioma. 

1. Most cases occur after forty; 
may occur earlier. 

2. Often a family history of 
cancer, or a history of association 
with cases of cancer. There may or 
may not be the history or evidence 
of syphilis. 

3. Epithelioma is usually single 
and confined to one side of the 
tongue. 

4. May be found on the under 
surface or any part of the tongue. 

5. Sometimes there is presented 
early the appearance of lingual 
psoriasis. Usually the epithelioma 
begins as a hard superficial swelling 
that tends to rapid ulceration. 
Sometimes an epitheliomatous ulcer 
or fissure appears without the pre- 
vious history of swelling or indura- 
tion. 

6. The surface of epithelioma 
bleeds readily; the discharge is pro- 
fuse, offensive and irritating. 



7. As a rule the more marked in- 
duration follows ulceration. 

8. The edges are thickened, ele- 
vated and irregular. 

9. Pain is a marked feature, 
usually lancinating in character and 
often radiating toward the ear. 

10. Disturbances of deglutition, 
mastication and speech. 

11. Cachexia. 

12. The submaxillary lymphatic 
glands are progressively enlarged 
and indurated. 

13. The microscope reveals endo- 
cytes, the ingrowing of the epithe- 
lium, and the cancer nests. 

14. Anti-syphilitic treatment is 
useless or harmful. 

15. Does not present the spiro- 
chete pallida, nor the Wassermann 
reaction, except in the presence of 
syphilis. A syphilitic is not immune 
from epithelioma. 



Gumma. 

1. Most cases occur before forty; 
but later age is not exempt. 

2. As a rule the cancer history 
is negative. Usually there is the 
history or evidence of syphilis. It 
should be remembered that cancer 
and syphilis may co-exist. 

3. Lingual gummata may be 
single, or multiple and bilateral. 

4. Prefers the dorsum or side of 
the tongue. 

5. Gumma begins as a nodule sit- 
uated more or less deep in the tis- 
sue, with subsequent softening and 
ulceration, to open on the surface 
as a deep excavation with a larger 
base than apex; the gummatous dis- 
charge differing markedly from the 
discharge of cancer. 

6. The gummatous ulcer does not 
bleed so easily, is covered by an ir- 
regular slough; and the compara- 
tively slight secretion is not so of- 
fensive nor irritating. 

7. Induration precedes ulcera- 
tion. 

8. The edges are more sharply 
defined and abrupt. 

9. There is comparatively little 
pain; even a large gumma may be 
present without pain. 

10. Comparatively little of such 
disturbance. 

11. Usually absent. 

12. The adenopathy is compara- 
tively slight; the glands may be 
swollen and tender, especially as the 
result of mixed infection. 

13. The microscope shows an ir- 
regular accumulation of granulation 
tissue, very different from the pic- 
ture of epithelioma. 

14. Anti-syphilitic treatment is 
specific. 

15. The spirochete pallida is dif- 
ficult to detect in the third stage 
of syphilis, but may be found. The 
Wassermann reaction is present, ex- 
cept when the case is quiescent or 
in the presence of active anti-syph- 
ilitic treatment. 



76 Diagnosis op Syphilis. 

Chronic abscess is more clearly defined from the adjacent 
tissue than gumma, and is usually more rounded in shape. 
Doubtful cases may be cleared up by puncture or the thera- 
peutic test. Rarely, an embedded foreign body resembles a 
gumma in general appearance, but the other symptoms of 
syphilis are lacking. 

Oral Chancre. 

Possibly history or evidence (gonorrhoea, chancroid, etc.) 
of exposure to syphilitic infection. 

Confrontation : Often valueless because of attempted 
deception. 

Derived from a preceding case of syphilis, directly 
or indirectly. 

Regular outline, smooth surface, sharply circumscribed 
base with cartilaginous induration. 

Incubation usually about two weeks ; may vary from one 
week to two months. 

Early involvement of neighboring lymphatics ; adenopathies 
usually appear within two weeks after the appearance of the 
chancre. 

Microscopic examination : Spirochete pallida present. 

Therapeutic test : Mercury is specific. 

Pain and discomfort comparatively slight. 

Duration : A few weeks. 

Termination : Recovery by resolution. Often leaves no 
visible scar or change, when located upon mucous membrane. 

Later appearance of second and third stages of syphilis, 
unless the disease is cured. 

Infectious : May result in infection of others. 

Oral Gumma. 

Usually firm to the touch. 

Usually occurs before forty. 

History or evidence of first and second stages of syphilis. 

Induration precedes ulceration. 



Diagnosis op Syphilis. 77 

Little or no pain. 

Microscopic examination : Granulation tissue ; possibly 
spirochete pallida. 

Wassermann reaction. 

Oral Epithelioma. 

Usually occurs after forty. 

May develop upon a syphilitic scar. 

Family history of cancer may be obtained. Often there 
has been association with cases of cancer. 

Induration usually more marked after ulceration. 

The edges are usually not - so sharply defined as in the 
gummatous ulcer. 

Cancer may occur in syphilitics. 

Pain is prominent. 

Greater interference with mastication and speech than 
in gumma. 

Cachexia more prominent than in gumma. 

Adenopathy usually more marked than in gumma. 

Microscopic examination : Endocytes, ingrowing epithe- 
lium and cancer nests. Spirochetes may be found, but not 
the spirochete pallida, except in syphilitics. 

Wassermann reaction absent, except in syphilitics. 

Odor: More pronounced than in syphilis, but may be 
largely obviated by treatment. 

General health: Impaired to a greater degree than in 
syphilis. 

Neighboring lymphatics: Usually not involved until after 
the first three months. 

Therapeutic test for syphilis is negative, except possibly 
the mercury may prove deleterious 

Sexual contact does not produce syphilis. 



78 Diagnosis of Syphilis. 

Leucoplacia buccalis, variously known as leuplasia buccalis, 
smoker's tongue, and ichthyosis, keratosis, and psoriasis of the 
tongue, is characterized by sharply circumscribed white patches 
of cornified epithelium. Ordinarily the patches are flat and 
raised. Sometimes they become more or less detached, leaving 
cracks or denuded surfaces. They are not confined to the 
tongue, but may occur on the lips and cheeks. They may 
occur in syphilitics, and possibly syphilis may be a factor in 
etiology, but they frequently occur in non-syphilitics. Exces- 
sive smoking seems to be a prominent factor in their causation, 
and most cases occur in men who are smokers. But the 
disease has been observed in men who do not smoke, and rarely 
in women. It is stated that in countries where women smoke 
as much as men, the disease shows the same preference for 
men, hardly ever affecting women. It is not affected by 
anti-syphilitic treatment. The spirochete pallida and the Was- 
sermann reaction are not present, except in concomitant 
syphilis. 

Oral Tuberculosis. 

Search for the tubercle bacillus is difficult, but makes the 
diagnosis absolute when found in the tissue. 

Tuberculin test positive in tuberculosis, but only indicates 
that the patient is suffering from a tubercular infection. 

Wassermann reaction absent, except in syphilitics. Syphilis 
and tuberculosis often co-exist. 

Adenopathy: Swelling of the lymphatics indicates tuber- 
culosis rather than late syphilis. 

Glossitis. 

Glossitis may be either superficial or deep ; and acute, 
subacute, or chronic. These inflammations may be due to 
many different causes. If the cause is not known, an appeal 
may be made to the therapeutic test for syphilis. The 
spirochete pallida and the Wassermann reaction speak for 



Diagnosis of Syphilis. 79 

syphilis, but do not exclude other causes of glossitis. Usually 
the diagnosis is easy, through a knowledge of the cause. 
Thus, in decubital glossitis, the knowledge of decubitus may 
aid in diagnosis. 



SYPHILITIC FISSURES AND ULCERS OF THE 
TONGUE. 

Second and Third Stages. 

Syphilitic fissures of the tongue are most frequent during 
the third stage of the disease. The fissures of the second 
stage are usually located upon the borders of the tongue, 
being caused largely by the rubbing of the teeth. In this 
way a fissure may follow the ulceration of a mucous patch 
that is irritated by a tooth. The syphilitic tongue seems 
prone to inflame and ulcerate. The sores and fissures show 
little inflammation, but they are usually very sensitive. Usually 
the fissures and ulcers are multiple. Tuberculous fissures 
are usually single. The secondary syphilitic fissures leave 
scars, usually depressed and smooth, sometimes thickened and 
raised white lines and patches, which may break down later 
to form new sores and fissures. These may again break down. 

Tertiary syphilitic fissures are more frequent. These may 
result from the breaking down of gummata. Deep and long 
fissures of the tongue are usually indicative of tertiary syphilis. 
Carcinoma more frequently causes a distinct tumor, which may 
become fissured or ulcerated. There is not the early appear- 
ance of long fissures and deep clefts observed in syphilis. 
Tuberculosis occasionally causes large ulcerated clefts, but not 
until the case is far advanced, when the diagnosis of tuber- 
culosis is usually easy. As a rule, the tuberculous fissure 
is small. 

The lymphatic glands are usually not enlarged, except 
accidentally, in either secondary or tertiary fissure of the 
tongue. 



80 Diagnosis of Syphilis. 

Secondary syphilitic ulcers of the tongue may result 
from the breaking down or injury of mucous patches; or 
they may occur as simple abrasions or cracks or fissured 
ulcers on the tip and borders. Injury from the teeth is a 
prominent cause. The ulcers due to breaking down of mucous 
patches, occur especially upon the tip and borders of the 
tongue, which are most exposed to injury by the teeth through 
rubbing or biting. Deep ulcers, especially, are frequently 
surrounded by a zone of infiltration, but this is rarely notice- 
ably harder than the normal tissue. Even in the presence 
of marked irritation, syphilitic ulcers show comparatively little 
inflammation, as a rule. Deep and ugly lesions may occur 
without marked inflammation. 

The small excoriations of the dorsum of the tongue, which 
occur near the tip and edges, or upon the tip and border 
of the tongue, may occur either in syphilis or other consti- 
tutional maladies. These may assume the form of small cracks 
or fissures. Usually there is little or no inflammation. Irri- 
tation by the teeth is a prominent cause. 

The ulcers are sensitive, though they show little or no 
inflammation. They may remain a long time without change 
in size, or they may slowly grow ; they do not readily undergo 
spontaneous improvement. 

In differential diagnosis, the presence of other signs of 
syphilis often is important, especially ulcers of the anus, 
nodes upon the tibia, or a syphilitic iritis. Many of the 
symptoms and signs found in syphilis, such as some of the 
ulcers just described, are not found only in syphilis, but may 
be present also in other affections. 

The tertiary syphilitic ulcers of the tongue may be 
superficial or deep, and leave deep furrows and marked deform- 
ity of the tongue. There is usually a preceding gumma, but 
this may be overlooked by the patient and not be observable 
at the time the case comes under treatment. Single ulcers 
may resemble tuberculosis or carcinoma of the tongue. Es- 
pecially when irritation is caused by a tooth, it may be difficult 
to recognize the syphilitic process and be sure that the ulcer 



Diagnosis of Syphilis. 81 

is not caused wholly by the tooth. The tertiary ulcers, like 
the gummata, have a preference for the dorsum, and may 
occur far back on the tongue. In these locations they are not 
likely to be mistaken for other ulcers. Men are most fre- 
quently affected, especially in middle life. But women, and 
even children, are not exempt. Gummatous ulcers usually 
do not show enlargement of the lymphatic glands. 

Tertiary syphilis of the salivary glands is usually recog- 
nized definitely by the therapeutic test. The glands most fre- 
quently involved are the sub-lingual gland, more rarely the 
sub-maxillary gland, and the Blandin-Nuhn (mucous) gland 
at the tip of the tongue. 

In general, syphilitic tumors of the mouth are characterized 
by firmness to the touch, and the absence of tenderness and 
acute inflammatory symptoms. Most difficulty is encountered 
in the tertiary affections of the palate, the roof of the 
pharynx, and the tongue. In the differentiation from carci- 
noma, it must be remembered that a syphilitic person may 
have cancer; and that a carcinoma may develop upon a 
syphilitic scar. In cases of doubt, the microscope should be 
used. Localized tuberculosis is even more difficult to diagnosti- 
cate at times. Unfortunately, in such cases it is often desirable 
to make the diagnosis without resorting to the therapeutic 
test, which would be debilitating. In such cases the tuberculin 
test is invaluable. The search for the tubercle bacillus in 
sections is difficult, but makes the diagnosis absolute when 
these are found in the tissue. However, it must be remembered 
that syphilis and tuberculosis may co-exist. Swelling of the 
lymphatics speaks for tuberculosis rather than for late syphilis. 
Redness and swelling are more marked in gumma than in 
tuberculous infiltration. This is not invariable, but the swelling 
in tuberculous ulcers is usually less than in gummatous ulcers. 

Late syphilis of the mouth must be differentiated from 
chancre, leucoplakia, and decubital glossitis. 



82 Diagnosis of Syphilis. 



Teeth. 



A peculiar malformation of the upper incisor teeth was 
described by Hutchinson. These are the so-called notched teeth. 
"Single vertical notches in their edges which, whilst themselves 
evidence of the atrophy of the middle tentacle, are often 
attended by a general dwarfing of the whole tooth, which is 
both too short and too narrow from side to side. In many 
cases this peculiar dwarfing and the central notch are suffi- 
ciently well marked to justify a diagnosis in themselves, but 
in many others they amount only to a suspicious condition 
and require corroboration by other facts. Such corroboration 
may be afforded by the physiognomy, by the keratitis, by 
deafness, or by the parental history." 

It must be remembered, however, that syphilis may cause 
notching of other teeth: and, furthermore, a similar condi- 
tion may be caused by non-syphilitic affections that impair 
the nutrition. 

Tonsils. 

Chancre of the tonsil has been observed, the inoculation 
occurring directly through coitus ah ore. musing from an 
affected breast, etc., or indirectly through the use of contami- 
nated utensils (cups, forks, spoons, etc.), or instruments. 
Usually the cases have been unilateral, though in some in- 
stances both tonsils may be involved. Founder describes four 
appearances of the tonsillar chancre: Anginous, diphtheroid, 
eroded, and ulcerative. In general, chancre of the tonsil causes 
that organ to be enlarged, indurated, reddened and painful. 
The characteristic adenopathy of chancre of the tonsil is a 
painless enlargement of one or several gland- at the angle 
of the jaw. In the throat there may be a sharp inflammatory 
reaction with dysphagia, painful adenitis, and fever. Such a 
case may present, at first, the appearance of a simple angina. 
But it is more persistent, and soon the characteristic changes 
appear in the tonsil. Sometimes chancre of the tonsil appears 



Diagkosis of Syphilis. 83 

first as a slight tonsillitis with a pseudo-membrane, resembling 
somewhat diphtheritic tonsillitis. Beneath the pseudo-mem- 
brane is the erosion and the indurated base of the chancre. 
In such cases the cervical glands are swollen, there is little 
pain, the affection is unilateral, does not extend beyond the 
tonsil, and runs its course in two to three weeks. Sometimes 
the chancre appears as an erosion or a more or less extensive 
ulceration upon an indurated base, with the characteristic 
adenopathy. Epithelioma shows also ulceration, induration and 
adenopathy, but the course is altogether different. The glands 
are affected earlier in syphilis, and there soon supervene the 
secondary symptoms of the disease. 

During the second stage of syphilis, the tonsils may be 
involved in an angina that some observers believe to be syph- 
ilitic. Others believe this to be a simple angina. The 
secondary syphilitic tonsilar lesions that are generally recog- 
nized are tonsillar hypertrophy and mucous patch of the 
tonsil. The hypertrophy resembles simple hypertrophy of the 
tonsil, is bilateral and causes little pain. Mucous patches 
may appear upon the enlarged tonsils, and there may be 
ulceration where the tonsils come together in the median line. 
There is cervical adenitis. The process may run its course in 
a few days or persist to become chronic. 

The mucous patch may appear upon the tonsil in various 
forms : Eroded, papulo-eroded, papulo-hypertrophic, and ul- 
cerative. The eroded and ulcerative forms are most common. 
The mucous patches seem to prefer smokers, drinkers, and those 
who use irritating substances in the mouth. Occasionally the 
hypertrophic patches may become exaggerated, to resemble 
diffuse papillomata. 

During the third stage of syphilis, the tonsil may be 
the seat of gummata and their resulting ulcerations. Gumma 
of the tonsil at first causes the tonsil to become enlarged, with 
little or no pain. Soon there is ulceration, usually by the 
time the case comes under the observation of the physician. 
The gummatous ulceration has a tendency to involve the edge 
of the tonsil and extend to affect the pillars of the fauces, 



84 Diagnosis op Syphilis. 

the velum, the pharynx or the base of the tongue, extending 
both in area and depth. The ulcer is clean-cut, the edges 
more or less red, inflamed and infiltrated, and it is covered 
with a pultaceous yellowish exudate, beneath which is a 
sanious, reddish, fungating surface. These cases of ulcerating 
gumma remain remarkably free from adenopathies, which is 
an important point in differentiation from chancre, epithelioma 
and tuberculosis of the tonsil. 

Sometimes the gumma assumes considerable proportions 
before it softens and ulcerates. Thus, Mackenzie mentions 
an extension of the softening of a gumma so as to involve the 
vertebral artery. Before ulceration, the softened gumma may 
present distinct fluctuation ; the overlying mucous membrane is 
injected, purplish-red in color. 

A gummatous ulcer shows little tendency to heal under 
the ordinary local treatment for simple ulcer, such as nitrate 
of silver, acid nitrate of mercury, etc., save when the patient 
is under general treatment for syphilis. Mackenzie regards 
the diagnosis as almost positive when such a suspicious ulcer 
persists in this way for four or five weeks. 

Esophagus. 

More careful and complete examinations of the esophagus 
will probably reveal syphilitic affection more often than the 
paucity of the literature would indicate. It is conceivable that 
a primary syphilitic sore might occur in the esophagus, for 
instance, through inoculation with an infected esophogeal 
bougie, esophagoscope, or other instrument introduced into the 
esophagus. Such an accident ought not to occur in practice. 
No cases of primary syphilis of the esophagus have been 
reported. 

During the second stage of syphilis, syphilides may occur 
in the esophagus. Such cases are rare ; they would be 
recognized by the presence of dysphagia, possibly by exami- 
nation through an esophagoscope, by other signs of syphilis, 
and by the therapeutic test. 



Diagnosis of Syphilis. 85 

Gumma have occasionally been observed in the esophagus, 
during the third stage of syphilis. There will usually be the 
presence and history of other signs and symptoms of the 
disease. The chief symptom is dysphagia. The gumma 
may be recognized by the use of the esophagoscope and the 
therapeutic test. 

The destructive lesions of syphilis may cause stricture 
of the esophagus. It is a pretty good general rule to think 
of syphilis in all cases of dysphagia. The dysphagia of 
syphilis is usually due to syphilitic affection of the pharynx 
or larynx. A neurotic dysphagia was observed by Wilson 
in a case of syphilis. In that case the paralysis of the 
esophagus responded to the therapeutic test. Maury and 
Bryant have recorded cases in which syphilitic stenosis of 
the esophagus necessitated gastrostomy. But in all cases, 
when practicable, it is well to resort to the therapeutic 
test, which has relieved or cured a number of cases. In the 
differentiation from carcinoma, it is well to remember the 
case noted by A. Weichselbaum, in which Podrazki made 
a diagnosis of syphilis of the esophagus, in a case of stricture, 
and the autopsy revealed a carcinoma. It has been suggested 
that this may have been a case in which a carcinoma devel- 
oped upon a gummatous infiltration. 

Stomach. 

No case of primary syphilitic sore in the stomach has 
been recorded. It is apparent that a primary inoculation 
of the stomach might occur through the use of an infected 
instrument, such as a stomach tube, gastrodiaphane, gastric 
electrode or gastroscope, that had not been properly sterilized 
after use in a case of syphilis. 

During the second and third stages of the disease, syphilitic 
ulcers and neoplasms may occur in the stomach. These 
are comparatively rare. In suspected cases, the presence or 
history of other signs or symptoms of the disease may be 
suggestive. The therapeutic test and the Wassermann reac- 
tion are of most value. 



86 Diagnosis of Syphilis. 

Chronic gastritis is a common symptom of syphilis. In 
such cases there is not always a direct syphilitic involvement 
of the stomach. Indeed, it has been suggested that the 
majority of cases are due to circulatory disturbances, passive 
congestions, hemorrhages, etc., produced by syphilis of other 
digestive organs, notably the liver, spleen and pancreas. It 
has been observed that a syphilitic gastritis frequently im- 
proves under the therapeutic test with mercury and the 
preparations of iodin, whereas non-syphilitic gastritis is 
usually made worse by these remedies. Depending upon 
whether there was involvement of the stomach wall in the 
syphilitic process, Chiari has divided these cases of gastritis 
into direct and indirect syphilis of the stomach. 

Ulcer of the stomach is not usually due to syphilis. But 
syphilis may cause ulcer of the stomach, either through the 
breaking down of a syphilide or gumma, or through increas- 
ing the predisposition to the formation of non-specific ulcera- 
tion from erosions, endarteritis, diminution of hemoglobin, 
reduction of the alkalinity of the blood, .and increase and 
disintegration of the leucocytes. Syphilitic ulcers some- 
times cause increased symptoms at night. Thus, Rosanow 
reported a case in which gastralgia occurred only at night; 
and Bartumeus emphasized the importance of nocturnal 
emesis in diagnosis. In all suspected cases it is important 
to exclude tuberculosis, alcoholism, chlorosis, and the various 
common causes of the non-syphilitic ulcer of the stomach. 
When this is possible and the therapeutic test is positive, 
the diagnosis is reasonably certain. 

Gumma of the stomach is a comparatively rare affection. 
But a number of cases have been reported, and in all sus- 
pected cases the therapeutic test should be considered. Usu- 
ally gumma of the stomach has been accompanied by a similar 
affection of other organs, especially the liver and lungs. 
There are usually signs or symptoms of the disease in other 
parts of the body. The gastroscopic appearance is somewhat 
suggestive, since the gummatous ulcer is usually irregular 
and not so clear cut as the simple ulcer of the stomach. 



Diagnosis of Syphilis. 87 

It is interesting to note that Birch-Hirschfeld and Chiari 
have reported cases of gumma of the stomach due to inher- 
ited syphilis. 

Gastric hemorrhage sometimes, though rarely, occurs in 
the course of syphilis. Such cases are benefitted by anti-syph- 
ilitic treatment, which is a useful point in diagnosis. In 
such cases, the hemorrhage may be due to congestion caused 
by involvement of other organs, such as the liver and spleen. 
Let us now take up the diagnostic points that are of 
value in differentiating between the various syphilitic affec- 
tions and the non-syphilitic affections of the stomach. A 
distinction should be made between simple ulcer of the stom- 
ach in a syphilitic and a gummatous ulcer with gastric 
catarrh. Furthermore, it should be remembered that various 
lesions of the stomach may co-exist. Thus, tubercle bacilli 
may become implanted upon a syphilitic lesion, just as they 
may grow upon carcinomatous or typhoid ulcers. Let us 
now consider briefly the following affections : 

(a) Syphilis of the stomach: 

1. Syphilitic neoplasm or infiltration. 

2. Syphilitic ulcer. 

(b) Syphilitic gastric catarrh, so-called indirect syphilis 
of the stomach, due to syphilis, but without direct involve- 
ment of the stomach. 

(c) Simple chronic gastric catarrh. 

(d) Simple gastric ulcer. 

(e) Cancer of the stomach. 

(f) Tuberculosis of the stomach. 

(g) Gastric neuroses. 

1 . Duration. 

(a) S3 r philis of the stomach is of indefinite duration, 
but must be regarded as a chronic affection. The affection 
of the stomach occurs both in inherited syphilis and in the 
acquired form of the disease, during the second and especially 
the third stage. 



88 Diagnosis op Syphilis. 

(b) Syphilitic gastric catarrh is also of indefinite dura- 
tion, usually chronic, and may develop from repeated attacks 
of acute gastritis. It may be an early symptom of syphilis, 
and occurs during the second and third stages of the 
disease. 

(c) Simple chronic gastric catarrh is of indefinite, fre- 
quently of long duration. 

(d) Simple gastric ulcer is of indefinite duration. The 
attacks are of short duration, but relapses and repetitions are 
frequent, so that the disease frequently lasts for years. 

(e) Cancer of the stomach is of comparatively short 
duration, the patients rarely living longer than six months 
or a year after the recognition of the disease. 

(f) Tuberculosis of the stomach may occur as a part 
of a miliary tuberculosis, or as a tuberculous ulcer (which 
is rare). The first of these affections is of short duration 
and often resembles the course of typhoid fever. The 
second is of indefinite duration. Third, the stomach is fre- 
quently affected in pulmonary tuberculosis, giving the picture 
of a toxic gastric catarrh. In such cases the outlook depends 
largely upon the condition of the stomach. On the other 
hand, the duration of the stomach affection in such cases 
depends largely upon the treatment of the tuberculosis. 
In the cases of tuberculosis that are curable, the stomach 
affection disappears with the recover}' of the patient from 
the tuberculosis. In the cases that are not curable, the 
duration may be placed at about two years. 

(g) The gastric neuroses vary in duration. Nervous 
gastralgia presents recurring attacks of rarely more than 
three or four days' duration. Hyperchlorhydria is of long 
duration. 

2. Sex. 

(a) Syphilis of the stomach shows no marked preference 
for either sex. In private practice (excluding prostitutes) 
most cases of syphilis occur in males. 

(b) Syphilitic gastric catarrh shows no marked difference 
between the sexes. 



Diagnosis op Syphilis. 89 

(c) Chronic gastric catarrh is more frequent in males. 

(d) Gastric ulcer is more frequent in women, in the 
proportion of about 2:1. 

(e) Cancer of the stomach occurs about equally in the 
two sexes. 

(f) Tuberculosis of the stomach is most frequent in 
males, in the proportion of 16:3 (Letorey), The toxic 
gastric catarrh of pulmonary tuberculosis I have observed 
most frequently in females. 

(g) The gastric neuroses vary in the two sexes. Thus, 
nervous gastralgia is most frequent in women, whereas hyper- 
chlorhydria is more frequent in men. 



3. Age. 

(a) Syphilis of the stomach is found in all ages. Thus, 
the stomach may be involved in the very young, in hereditary 
syphilis. In the acquired form of the disease, the stomach 
is involved most frequently from twenty-five to forty years. 

(b) Syphilitic gastric catarrh is also found at all ages, 
in the very young in hereditary syphilis, and from early 
adolescence on, in the acquired form of syphilis. Occurs 
most frequently between the third and sixth month of the 
disease. 

(c) Chronic gastric catarrh is a disease of mature age. 

(d) Ulcer of the stomach is more rare in youth, fre- 
quently increasing progressively from puberty to advanced 
age. 

(e) Cancer of the stomach is found especially in middle 
and advanced life. 

(f) Tuberculosis of the stomach prefers children and 
young adults. 

(g) The gastric neuroses: Nervous gastralgia prefers 
the years from eighteen to thirty-five. Hyperchlorhydria 
may occur at any age, but is rare in youth. 



90 Diagnosis of Syphilis. 



(a) Coated in syphilis of the stomach. 

(b) Coated, slightly furred, in syphilitic gastric catarrh. 

(c) Coated grayish white in simple chronic gastric catarrh, 
frequently showing impression of the teeth. This is frequently 
observed also in syphilis. 

(d) In ulcer of the stomach the tongue may be dry 
and red with a white stripe in the middle, or it may be 
smooth and moist, or slightly furred. 

(e) Cancer of the stomach is marked by a heavily coated 
tongue comparatively early in the course of the disease. 

(f) In tuberculosis, the tongue is coated as a rule. 

(g) The appearance of the tongue varies in the gastric 
neuroses. It is usually normal in nervous gastralgia. In 
hyperchlorhydria the tongue may he clean or slightly furred. 

•"/. Sensations. 

(a) Syphilis causes a variety of subjective symptoms. 
Their chief characteristic seems to be that they are mild 
compared with the extent of the lesions. Some have ob- 
served that gastralgia occurs especially at night in cases 
of syphilis. 

(b) Syphilitic gastric catarrh may be accompanied by 
gastralgia and headache. 

(c) Chronic gastric catarrh presents the familiar picture 
of pressure, fullness and distention. 

(d) In gastric ulcer there may be burning in the stomach, 
and circumscribed boring pains, frequently radiating to 
the back. 

(e) Cancer of the stomach is marked by an exaggera- 
tion of the symptoms of catarrh in conjunction with pain, 
that is of variable character and later radiates toward 
the shoulder. 

(f) Tuberculosis may cause nothing abnormal in the 



Diagnosis op Syphilis. 91 

way of sensations, or there may be anorexia, indigestion, 
nausea, distention, or vomiting. 

(g) The neuroses are marked by a great variety of 
sensations. Nervous gastralgia may cause feeling of hot 
or cold. Hyperchlorhydria is marked by sensations of heat 
and burning, and at times by pyrosis and distention. 

6. Appetite. 

(a) In syphilis of the stomach there is comparatively 
little impairment of the appetite. 

(b) Indirect syphilis of the stomach is sometimes asso- 
ciated with polydypsia, and rarely with bulimia. 

(c) Simple chronic catarrh of the stomach tends to 
impair the appetite, so that it is usually absent. 

(d) Gastric ulcer does not impair the appetite. The 
patients often restrict their eating to the point of causing 
emaciation, because they fear the food may cause pain. 

(e) Cancer destroys thee appetite, and this is a marked 
characteristic of the disease. 

(f) In miliary tuberculosis and tuberculous ulcer the 
appetite is impaired. In miliary tuberculosis the patient 
is often too sick to care to eat. In pulmonary tuberculosis 
the appetite is often remarkably good ; sometimes there is 
early impairment of the appetite ; sometimes there is anorexia, 
which may be complete or partial, i. e., for all foods or 
for only certain foods. Thus, there may be anorexia for 
digestible articles, while indigestible delicacies may be craved. 
In some cases a seemingly voracious appetite is satisfied 
with a few mouthfuls of food. 

(g) The appetite varies in the neuroses. In nervous 
gastralgia the appetite is normal during the intervals ; in 
hyperchlorhydria the appetite is often increased. 

7. Epigastric Pain. 

(a) In syphilis there is gastralgia. In syphilitic ulcer, 
gastralgia occurs especially at night (Rosanow). 



92 Diagnosis op Syphilis. 

(b) There may be gastralgia in syphilitic gastrict catarrh. 

(c) In chronic gastric catarrh, epigastric pain may be 
present but is not regularly pronounced. More often there 
is only diffuse tenderness. Atrophic gastritis may present 
lancinating pains. 

(d) In ulcer the epigastric pain is intense, especially 
after eating, and becomes more severe upon pressure. The 
pain disappears after digestion is completed and the stomach 
is empty. 

(e) Cancer causes less intense pain, but it is more 
continuous and there are seldom periods of perfect freedom 
from pain, such as are observed in ulcer. 

(f) The epigastric pain is usually diffuse in miliary 
tuberculosis. The pain may be localized in tuberculous ulcer. 
The toxic gastritis observed in pulmonary tuberculosis usually 
presents a diffuse tenderness in the epigastric region. 

(g) The epigastric pain of nervous gastralgia is not 
dependent upon the taking of food, is relieved by pressure, 
and there are intervals of a number of days during which 
there is complete freedom from pain. In hyperchlorhydria, 
the epigastric pain appears from one to three hours after 
meals, and is relieved by antacids. 



8. Regurgitation. 

(a) Not characteristic in syphilis of the stomach. 

(b) May be present in syphilitic gastric catarrh. 

(c) Frequently present in chronic gastric catarrh. 

(d) At times present in gastric ulcers. There is fre- 
quently water-brash and pyrosis. 

(e) There is no water-brash in cancer of the stomach; 
pyrosis may be quite intense. 

(f) Present in some cases, bitter, acid, pungent, espe- 
cially late. 

(g) Not present in nervous gastralgia. In hyperchlor- 
hydria water-brash and pyrosis are frequent. 



Diagnosis op Syphilis. 93 

9. Blechmg. 

(a) Frequent eructations in syphilis of stomach. 

(b) Frequently present in syphilitic catarrh of the stomach. 

(c) Frequent copious eructations in chronic gastric ca- 
tarrh. 

(d) Usually absent in ulcer, and when present is with- 
out bad odor. 

(e) Usually present in cancer of the stomach, often asso- 
ciated with disagreeable, sometimes fetid odor. 

(f ) Present in some cases of tuberculosis. 

( g ) Variable in nervous gastralgia ; excessive in hyper- 
chlorhydria. 

10. Fever. 

(a) Usually there is fever in syphilis of the stomach. 

(b) Rare in syphilitic gastric catarrh, except when due 
to complications. 

(c) Rare in simple chronic catarrh of the stomach; some- 
times the temperature is subnormal. 

(d) In gastric ulcer there may be fever, in the presence 
of adhesive inflammation caused by perforation of the ulcer, 
or in connection with large hemorrhages. 

(e) Rare in cancer, except towards the close of the scene. 
The temperature may be subnormal. 

(f) Fever is present in tuberculosis, especially in the 
evening. 

(g) The gastric neuroses do not cause fever. 

11. Taste. 

(a) Not characteristic in syphilis, frequently resembles 
that of catarrh. 

(b) Variable in syphilitic gastrict catarrh. 

(c) Pasty, decomposed, sour, bitter, in chronic gastric 
catarrh. 

(d) Normal in ulcer of the stomach. 



94 Diagnosis of Syphilis. 

(e) Resembles that of catarrh, but exaggerated in cancer. 
Often bitter and sour. 

(f) Often eructations of bad tasting material in tuber- 
culosis. 

(g) Normal in the gastric neuroses. 

/ .'. Hematemesis. 

(a) Rare in syphilis of stomach. Hayem reports a case 
in which the hemorrhage ceased after the administration of 
iodide of potash. Hematemesis in syphilitica is usually dw 
to hepatic congestion. 

(b) Absent in syphilitic gastric catarrh. 

(c) Absent in chronic gastric catarrh. 

(d) One of the characteristic symptoms in ulcer. Almost 
all cases show blood upon microscopic examination of the 
stomach contents. Often these patients vomit large quantities 
of blood, either clear red or coffee ground in color. After a 
hemorrhage, there may be hematemesis, also on the following 
day, but when arrested the hematemesis does not reappear for 
quite a long period. 

(e) Blood may frequently be found microscopically in 
cancer. In gross hematemesis the quantity of blood is rela- 
tively >mall, usually coffee ground in color, decomposed, fre- 
quently of fetid odor. Recurrences are frequent, with short 
intermissions. 

(f) Hematemesis is absent in miliary tuberculosis, rare in 
tuberculous ulcer of the stomach, and absent in the toxic gas- 
tric catarrh of pulmonary tuberculosis, save the vomiting of 
blood from a pulmonary hemorrhage. 

(g) Absent in the neuroses. 

13. Secretory Function. 

(a) Various alterations have been observed in syphilis, the 
most common being a reduction or arrest of the gastric secre- 
tion, probably due to an associate catarrh. 






Diagnosis of Syphilis. 9"> 

(b) There is no characteristic change observed in indirect 
syphilis. 

(c) Chronic catarrh of the stomach tends to arrest the 
secretion, except in gastritis acida. 

(d) In gastric ulcer the secretion of hydrochloric acid is 
usually increased, lactic acid is absent, and the ferments are 
increased. 

(e) Cancer of the stomach is marked by early absence of 
free hydrochloric acid, the presence of lactic acid, and the 
absence of the ferments. 

(f) In tuberculosis the secretory function of the stomach 
is little or not at all impaired. In extreme cases of phthisis 
the hydrochloric acid is often reduced. 

(g) The neuroses show great variations in the secretory 
function. Nervous gastralgia shows a variable amount of 
hydrochloric acid, absence of lactic acid, and the ferments are 
normal. Hyperchlorhydria is marked by an increase of hydro- 
chloric acid, and the ferments are also increased. 

lJf. Vomiting. 

(a) Vomiting is not characteristic in syphilitic neoplasm 
or infiltration ; may take place a few hours after eating. In 
syphilitic ulcer, Bartemeces observed vomiting especially at 
night. 

(b) There may be vomiting in indirect syphilitic catarrh, 
but it is not characteristic, save that it is benefited by anti- 
syphilitic treatment. 

(c) In chronic catarrh of the stomach, vomiting is espe- 
cially frequent in the cases due to alcohol. 

(d) Gastric ulcer does not show vomiting as a marked 
feature ; it usually occurs after meals, if at all. 

(e) Cancer shows vomiting as a marked feature, not after 
meals, but once or twice a day or once every day or two, the 
quantity being often very large. 

(f) In tuberculosis there is often retching and vomiting, 
especially with the morning spell of coughing. 



96 Diagnosis of Syphilis. 

(g) Nervous gastragia shows no regularity in the appear- 
ance of vomiting ; absent in hyperchlorhydria. 



15. Perforation. 

(a) Rare in syphilis. 

(b) Absent in indirect syphilis of stomach. 

(c) Absent in chronic catarrh. 

(d) May take place in ulcer after a short period of ill- 
ness, or at any time in the course of the disease. 

(e) Occurs in cancer, late in the course of the disease. 

(f) Absent in miliary tuberculosis, and rare in tubercu- 
lous ulcer. 

(g) Absent in the neuroses. 

16. Tumor. 

(a) In some of the reported cases of syphilis of the stom- 
ach, the tumor has been large enough to palpate. The edges 
of syphilitic ulcers are usually more thickened than the edges 
of simple ulcer of the stomach. 

(b) Syphilitic catarrh does not cause a tumor. 

(c) There is no tumor in chronic catarrh of the stomach, 
save the thickening of the stomach walls that may be present 
in the hyperplastic form. 

(d) Ulcer of the stomach does not cause a tumor; when 
near the pyloris, the latter may be thickened so that it feels 
like a smooth elongated body. 

(e) The presence of tumor is one of the most reliable signs 
of cancer of the stomach. Usually the tumor soon becomes 
large enough to be palpable, presenting an uneven surface, 
painful to pressure, and easily movable early in the course of 
the disease. 

(f) Tuberculosis is marked by single or miliary nodules 
that are not palpable. Tumor is absent in tuberculous ulcer. 

(g) Tumor is absent in the neuroses. 



Diagnosis of Syphilis. 97 

17. Complexion, Cachexia and Changes in the Blood. 

(a) Syphilis is marked by anemia, reduction of the eryth- 
rocytes and hemoglobin, and late cachexia. Eruptions. 

(b) In syphilitic gastric catarrh there is reduction of the 
erythrocytes and hemoglobin, which is a prominent cause of 
the malnutrition in syphilitics. 

(c) In chronic gastric catarrh, the patients are pale and 
show malnutrition. 

(d) In gastric ulcer the complexion is more fresh than in 
catarrh ; there is anemia after severe losses of blood. 

(e) Cancer is marked by a sallow, yellowish complexion, 
dry skin, and the early appearance of cachexia. 

(f) In tuberculosis there is anemia, hectic, and cachexia. 

(g) In nervous gastralgia the complexion is pale during 
the attacks, and normal during the intervals. In hyperchlor- 
hydria the complexion may be pale or normal. 



18. Stools. 

(a) Not characteristic. There may be colic and diarrhoea 
in recent syphilis. 

(b) There may be colic and diarrhoea in syphilitic gastric 
catarrh. 

(c) Constipation alternating with diarrhoea is a common 
picture in chronic gastric catarrh. 

(d) In ulcer constipation is the rule; the stools may be 
tinged with blood. Indeed, blood may usually be found in 
the stools microscopically. 

(e) There may be constipation or diarrhoea in cances; the 
stools may contain blood. 

(f) Usually there is constipation in tuberculosis. 

(g) The stools vary in the neuroses, usually normal in 
nervous gastralgia, constipated in hyperchlorhydria. 



98 Diagnosis of Syphilis. 



19. Urine. 



(a) The condition of the urine varies in syphilis of the 
stomach. Usually the urine is concentrated, reduced in quan- 
tity ; the urates and phosphates are reduced in some cases ; 
indican is increased in the presence of ulceration. 

(b) Indirect syphilis of the stomach does not cause marked 
changes in the urine. Sometimes the urine is increased in 
quantity, of light specific gravity, but this is not constant. 

(c) In chronic gastritis the total acidity of the urine is 
lessened, and there is a reduction of urates and phosphates. 

(d) In ulcer the quantity is reduced and the urine con- 
tains indican. 

(e) Cancer is marked by a concentrated dark urine, of 
neutral or alkaline reaction ; indicanuria, acetonuria, sometimes 
peptonuria ; the preformed and ethereal sulphates are increased. 

(f) In tuberculosis the urine often contains phosphates in 
excess. The reduction in the quantity of urine is in ratio to 
the temperature, as a rule. 

(g) The condition of the urine varies in the neuroses. 
Nervous gastralgia presents little change, save that the quan- 
tity may be increased during the attacks. In hyperchlor- 
hydria the urine is often neutral or alkaline ; the phosphates 
are increased. 

20. Tissue Fragments. 

(a) In syphilis of the stomach the contents may contain 
pus and necrotic tissue. 

(b) Syphilitic catarrh of the stomach presents nothing 
characteristic, except possibly some mucus and a few leuco- 
cytes. The latter, at least may often be accounted for by the 
deglutition of the discharge from the retropharynx. 

(c) In chronic catarrh of the stomach, lavage may reveal 
fragments showing chronic inflammation. 

(d) In ulcer, lavage usually reveals no tissue fragments. 
The microscope may show minute traces of blood. 



Diagnosis of Syphilis. 99 

(e) In cancer, tissue fragments may sometimes be found 
in the stomach contents showing microscopically the structure 
of the neoplasm. 

(f) Tissue fragments are usually absent in tuberculosis. 

(g) Usually absent in the neuroses. It has been claimed 
that they may be present in hyperchlorhydria, showing gland- 
ular hypertrophy in two-thirds of the cases. 

21. Microscopic Examination. 

( a ) Syphilis of stomach : Pus cells ; necrotic tissue, pos- 
sibly fragments of a gumma. The spirochete pallida should 
be looked for. The presence of the Wassermann reaction 
would indicate syphilis, but would not exclude a non-syphilitic 
affection of the stomach. 

(b) Syphilitic catarrh of the stomach: Leucocytes, and 
possibly fragments showing inflammation of the mucous mem- 
brane. 

(c) Chronic gastric catarrh: Leucocytes, and fragments 
showing chronic inflammation of the mucous membrane. 

(d) Ulcer: Usually some red blood cells may be found. 

(e) Cancer: Possibly fragments of neoplasm. Opper-Boas 
bacillus. 

(f) Tuberculosis: Tubercle bacilli, especially from in- 
gested sputum. 

(g) Gastric neuroses: Usually none. Hyperchlorhydria 
may present fragments, in two-thirds of cases, showing proli- 
feration of glands. 

22. Dorsal Pain Points. 

(a) Not characteristic in syphilis of the stomach. May 
be present in syphilitic ulcer, but then usually not so marked 
as in simple ulcer. 

(b) Absent in syphilitic catarrh. 

(c) Absent in chronic catarrh. 



100 Diagnosis of Syphilis. 

(d) Present as a valuable diagnostic point in ulcer, one 
inch to the left of the twelfth dorsal vertebra. 

(e) The pain in cancer is diffuse and not characteristic. 

(f) Not present in tuberculosis, except in the rare cases 
of tuberculous ulcer of the stomach. 

(g) There is no characteristic dorsal pain in the neuroses. 

23. Administration of Mercury and the Iodides. 

(a) Beneficial in syphilis. It has been suggested that if 
the condition improves under the iodide of mercury and be- 
comes worse when the drug is discontinued, to again improve 
when the drug is again administered, the diagnosis of syphilis 
is reasonably certain. 

(b) Beneficial in syphilitic catarrh. In this respect in- 
direct syphilis of the stomach differs from the gastric catarrh 
due to injudicious use of the anti-syphilitics, in which condi- 
tion their further administration is injurious, at least for 
a time. 

(c) Injuring in chronic catarrh. 

(d) Injurious in ulcer. 

(e) Usually there is little effect in cancer. Sometimes anti- 
syphilitics are injurious. Again, in some cases improvement 
has been noted for a time, especially under the use of large 
doses of preparations of iodine. 

(f) Not beneficial, and often absolutely injurious in 
tuberculosis. 

(g) The neuroses are not benefited by anti-syphilitic 
treatment, as a rule ; when there is such improvement, it 
suggests the possibility of syphilis as an etiological factor. 

2£. Prognosis. 

(a) Syphilis of the stomach: Improvement under anti- 
syphilitic treatment. In these cases there is ofen syphilis 
elsewhere, especialy in the liver. 






Diagnosis op Syphilis. 101 

(b) Syphilitic gastric catarrh: Disappears under anti- 
syphilitic treatment. 

(c) Improvement under dietetic treatment occurs in chronic 
gastric catarrh. 

(d) Marked improvement under dietetic treatment is ob- 
served in ulcer. 

(e) Usually any improvement is only temporary in cancer. 
A few cases have ben apparently recued by early surgery. 

(f) The outlook is bad in miliary tuberculosis and tuber- 
culous ulcer of the stomach. The toxic gastritis of pulmonary 
tuberculosis improves under creosote, fresh air, and the use of 
tuberculin. 

(g) The neuroses show marked improvement under treat- 
ment. 

We have referred to the frequency of affection of the liver 
in syphilis of the stomach. In cancer of the stomach, the 
liver is also frequently involved. Both cancer of the stomach 
and chronic gastric catarrh are often accompanied by catarrhal 
jaundice. 

In miliary tuberculosis of the stomach there is often affec- 
tion also of other parts of the body, especially the intestines. 
Tuberculous ulcer of the stomach is usually, if not invariably, 
accompanied by pulmonary tuberculosis. 

Intestine. 

Of the syphilitic affections of the intestines, we are most 
familiar with ulceration of the small intestine. This occurs 
most frequently in hereditary syphilis, though cases have been 
observed in adults. Altogether, syphilitic affection of the in- 
testine is probably more common than syphilis of the stomach. 
Not infrequently syphilis of the intestine accompanies syphilitic 
affection of the stomach; but syphilis of the intestine may 
occur independent of affection of the stomach. In diagnosis, 
the presence of a persistent diarrhoea that is relieved or cured 
by anti-syphilitic treatment, is suggestive. 



102 Diagnosis of Syphilis. 

Care must be taken to differentiate the affection of the 
intestine so frequently observed during the treatment of syph- 
ilis, in which the diarrhoea is due to the administration of anti- 
syphilitics. 

Syphilitic affection of the intestine seldom causes perfora- 
tion or peritonitis. 

(Syphilis of the rectum will be considered later.) 

Syphilis of the intestine should be differentiated especially 
from : 

1. Intestinal catarrh due to anti-syphilitics. 

2. Intestinal tuberculosis. 

3. Intestinal cancer. 

4. Simple intestinal catarrh. 

5. Simple ulcer. 

1. Intestinal catarrh due to the administration of anti- 
syphilitics, is made worse by a continuance of these remedies. 
Direct syphilitic affection of the intestine is improved by 
specific treatment. The intestinal catarrh due to these rem- 
edies, disappears upon their discontinuance. 

2. Intestinal tuberculosis is marked by pain, which is much 
less conspicuous in syphilitic affections of the intestine. Tuber- 
culosis of the intestine is always, or almost always, accom- 
panied by pulmonary tuberculosis. Anti-syphilitic remedies 
do harm rather than good; recovery or improvement follows 
anti-tubercular treatment. These cases often show constipa- 
tion ; syphilis of the intestine almost always is marked by 
diarrhoea. Frequently tuberculosis of the intestine is part 
of a miliary tuberculosis, with evidence of the affection in 
other parts of the body. Some of the most interesting cases, 
from the standpoint of differential diagnosis, are those in 
which there is evidence of affection of the intestine in indi- 
viduals who suffer from both pulmonary tuberculosis and 
syphilis. In such cases we must take into consideration the 
possibility of the affection of the intestine being due to the 
injudicious use of anti-tubercular remedies. Such cases are 
distinctly injured by a continuance of such remedies, and also 



Diagnosis op Syphilis. 103 

by the use of the anti-syphilitics. Sometimes affection of the 
intestine apparently results from the swallowing of sputum, 
in pulmonary tuberculosis, presenting the picture of an ordi- 
nary intestinal catarrh. 

S. Intestinal cancer involves most frequently the rectum, 
and will receive further consideration in connection with the 
differential diagnosis from syphilis of the rectum. 

Carcinoma of the intestine, aside from the affection of 
the rectum, is not nearly so common as carcinoma of the 
stomach. However, it is the most frequent intestinal neoplasm. 
Often the disease may exist for some time before symptoms 
are noticed. The most characteristic symptoms are the early 
cachexia, the presence of a tumor, malnutrition, and obstruc- 
tion of the bowel. The obstruction of the bowel may dis- 
appear under treatment to reappear again later. The condi- 
tion is progressive. Sometimes a tumor may not be detected. 
The other symptoms depend largely upon the location of the 
carcinoma. Aside from syphilis, carcinoma of the intestine 
should be differentiated from tuberculosis, dysentry, typhoid 
fever; carcinoma of the pyloris or gall-bladder, pancreas or 
omentum; echinococcus of the omentum, retroperitoneal neo- 
plasms, neoplasms of the uterus and its adnexa, intestinal con- 
cretions (gall-stones, feces), appendicitis, and tumors of the 
kidney or spleen. 

Intestinal sarcomata and lymphosarcomata are rare, and 
are usually found in the small intestine. (Carcinoma is more 
frequent in the large intestine). There is a marked tendency 
to metastases, and the course is more rapid than in carcinoma 
or syphilis. 

Benign intestinal neoplasms (adenomata, fibromata, lip- 
omata, papillomata, angiomata, myomata, fibromyomata, 
myxomata, and fibromyxomata) may cause diarrhoea, with the 
discharge of mucus, pus, or blood; or intestinal obstruction 
and hemorrhage. 

All of these non-syphilitic affections are benefited little 
or not at all, or absolutely injured by the administration of 
anti-syphilitics. Often the microscopic examination of the 



104 Diagnosis of Syphilis. 

stools will reveal characteristic fragments of tissue that will 
make the diagnosis. 

4. Simple intestinal catarrh may sometimes resemble syph- 
ilitic affection of the intestine. Aside from indirect syphilitic 
catarrh of the intestine, simple intestinal catarrh is made worse 
by the continued administration of anti-syphilitics, especially 
the iodides. In simple catarrh most may be accomplished by 
dietetics ; in syphilis, by specific treatment. The fact must 
not be lost sight of, in diagnosis, that syphilitic patients may 
suffer from simple intestinal catarrh. However, symptoms of 
syphilis in other parts of the body are often of value in 
leading to the recognition of syphilis of the intestine. 

5. Ulcer of the intestine may be due to a great many 
causes. Aside from catarrhal and follicular ulceration, which 
may be considered exaggerated forms of intestinal catarrh, 
syphilitic ulcers of the intestine must be differentiated from 
duodenal ulcer, embolic and thrombotic ulcers, amyloid ulcers, 
tuberculous ulcers, toxic ulcers, and the ulcerations of typhoid 
fever, dysentery, and cancer. 

If we except the rectum, which we will consider later, 
syphilitic ulcers occur most frequently in the small intestine 
in infants with hereditary syphilis, and result from the 
breaking down of gummata. They have also been observed 
in adults. 

Liver. 

Other organs, especially the liver, are frequently involved 
in syphilis of the stomach. From a diagnostic standpoint it 
is unfortunate that this is also true of other diseases of the 
stomach, notably cancer. It is important to bear this fact 
in mind when called upon to make a differential diagnosis 
between cancer and syphilis. 

In the time of Galen, congestion of the liver was be- 
lieved to be a prominent cause of syphilis. Some observers 
(Gubler, Leudet, Moulard), have described the icterus that 
frequently occurs early in the course of syphilis. Some be- 
lieve this to be the first sign of syphilitic hepatitis. This 



Diagnosis op Syphilis. 105 

icterus is not always preceded by digestive disturbances, though 
at the same time the liver may be tender to pressure. Senator 
has suggested that such an icterus may be due to swelling 
of the bile ducts caused by a syphilitic erythema. Virchow 
has observed that it is probable that gummata generally de- 
velop upon soil prepared for them by the earlier syphilitic 
manifestations of syphilis. In some cases icterus may be 
caused by enlargement of the lymphatic glands of the portal 
vein (Engel-Reimers). Probably the most frequent cause of 
icterus in syphilis is a simple catarrh of the gall-ducts. The 
fact must not be overlooked that such a catarrh may be caused 
by the injudicious internal administration of medicines or by 
indiscretions regarding the ingesta. The latter explanation 
will account for many cases, since syphilitics are not infre- 
quently alcoholics. Further, it is possible that chemical 
poisons formed by the syphilitic process may cause 
icterus through irritation, possibly during excretion, without 
an active syphilitic process being present in the liver. This 
possibility has given rise to the term syphilotoxic icterus. A 
similar icterus has been described in a number of infections 
and in ptomaine poisoning. 

An acute yellow atrophy of the liver has occasionally been 
reported early in the course of syphilis. In these cases there 
is marked atrophy of the liver, frequently with enlargement 
of the spleen and the presence of cerebral symptoms. Senator 
points out that tyrosin is more frequent in the urine in this 
condition, whereas it is absent or present only in traces in 
phosphorus poisoning. 

During the third stage of syphilis, gummata may occur 
in the liver. The gummata may be either diffuse or circum- 
scribed. Rindfleisch has suggested that the diffuse hepatitis 
of heriditary syphilis may be a cause later of cirrhosis in 
young persons, the gummata being converted into connective 
tissue. This is also possible in the acquired form of the 
disease. Circumscribed gummata vary in size up to that of a 
walnut. In diagnosis, it is important to remember that these 
may occur either upon the surface or edge of the organ or 



106 Diagnosis of Syphilis. 

deep in the substance of the liver, where they may not be 
palpated. These may undergo cheesy degeneration or soften 
and become absorbed. The resulting fibrous tissue then con- 
tracts and distorts the liver. Fibrous bands formed in this 
way, may isolate portions of the liver, that may remain ap- 
parently normal or undergo fatty or amyloid change. So 
there may be a marked diminution in the size of the liver. 
Or the liver may be enlarged, especially in amyloid degen- 
eration. 

Perihepatitis frequently causes the formation of adhesive 
bands, especially upon the convex surface, sometimes binding 
the liver to the diaphragm, less frequently forming adhesion 
with the stomach or colon. 

Syphilis of the liver is frequently accompanied by other 
manifestations of the disease, especially enlargement of the 
spleen, amj'loid changes in the kidneys, and enlargement of 
the lymphatic glands. There are also frequently other signs 
and symptoms of the disease. 

We have already referred to icterus. During the third 
stage of syphilis, even in the presence of gumma of the 
liver, icterus is frequently absent. On the other hand, when 
icterus occurs as the result of the pressure of a gumma or 
the resulting cicatricial contraction, it will prove stubborn, 
probably disappearing only with the destruction of the 
involved secreting portion of liver tissue. 

Usually syphilis causes first an increase in the size of 
the liver, followed by a diminution of its size. Sometimes 
palpation may detect nodules or irregularities of the surface 
or border of the organ. 

Ascites may result from pressure involving the portal 
vein, which at times may cause hemorrhages from the stomach 
and intestines. 

In suspected syphilis of the liver, the diagnosis may be 
influenced by evidence of the disease in other parts of the 
body, by enlargement of the spleen, amyloid disease of the 
kidneys with consequent albuminuria and cachexia. 

Often it is important to differentiate between syphilis and 



Diagnosis op Syphilis. 107 

cancer of the liver. Usually cancerous nodules are of rapid 
growth compared with the syphilitic nodules. Furthermore, 
in cancer of the liver there is more constant pain, a more rapid 
breaking down of the tissue, and a greater degradation of 
the strength than in syphilis, whereas enlargement of the 
spleen and the presence of albuminuria would speak for the 
latter disease. 

In diagnosis, it may be important to recognize: 

1. Hepatic congestion. 

2. Hepatitis. 

3. Perihepatitis. 

4. Pylephlebitis. 

5. Pigment liver. 

6. Diaphragmatic pleurisy. 

7. Icterus (various causes). 

8. Gummata. 

9. Cancer of liver or gall-bladder. 

10. Tuberculosis of liver. 

11. Gall-stones. 

12. Cirrhosis (various causes). 

13. Amyloid disease. 

In making these differentiations, it should be remembered 
in syphilis we may find the spirochete pallida and the Was- 
sermann reaction. The spirochete pallida may be found in 
the blood. The examination is often difficult, requiring a pro- 
longed search. When found, the evidence of syphilis is con- 
clusive, but it does not indicate positively that any certain 
affection is syphilitic ; it may be a non-syphilitic affection 
occurring in a syphilitic patient. 

The last remark holds good with reference to the Was- 
sermann reaction. As a working rule, we may rely upon this 
reaction being present in syphilis, unless the disease is quiescent 
or the patient has been subjected to anti-syphilitics. 

Syphilitic hepatitis may be interstitial or parenchymatous ; 
syphilotoxic or gummatous. 

1. The simplest affection of the liver is congestion, marked 



108 Diagnosis of Syphilis. 

clinically by pain in the right shoulder and loin, sensations 
of weight and tension in the right hypochondrium especially 
after meals, and the presence of nausea and vomiting. With 
this there is derangement of the bowels, frequently diarrhoea, 
coated tongue, flatulency, depression of spirits, loss of appe- 
tite and strength, some enlargement of the liver, and possibly 
slight jaundice. 

2. Hepatitis presents a similar array of symptoms, with 
the addition of fever. There may be enlargement of the 
spleen and the presence of albuminuria. The liver is slightly 
tender to pressure, but the pain is of a dull character, and 
not so marked as in perihepatitis. Both hepatitis and peri- 
hepatitis may be due to syphilis. A useful point in diagnosis 
is the fact that syphilitic affection of the other abdominal 
viscera, notably the intestine and stomach, is almost invariably 
accompanied by hepatic syphilis. It is not always easy to 
make a differentiation between congestion and actual inflam- 
mation of the liver. As stated the chief clinical difference is 
the presence of fever in hepatitis. But fever may be due to 
some other cause, so that there may be congestion and fever 
without actual inflammation. 

3. Primary perihepatitis is almost invariably syphilitic. 
Secondary hepatitis results from extension of disease from 
other parts, notably from the stomach, intestine, diaphragm, 
and pleura ; or it results from a chronic peritonitis, or from 
disease of the liver. The chief symptoms are tenderness upon 
pressure, motion or inspiration, sometimes the presence of a 
friction sound, and enlargement of the liver. Jaundice is 
absent and there is slight fever. 

4. Pylephlebitis may resemble hepatitis. The most use- 
ful diagnostic signs, as a rule, are the presence in pylephlebitis 
of acute and painful enlargement of the liver, jaundice, thin 
and copious stools, irregular fever and profuse sweats, occa- 
sional chills, emaciation, enlarged spleen, typhoid symptoms, 
pain in the epigastrium or right hypochondrium or radiating 
to the lumbar or sacral regions, later swelling of the veins 
of the abdominal walls, and possibly septic fever and peri- 



Diagnosis of Syphilis. 109 

tonitis. Suspicion may be aroused by the knowledge of a 
previous affection of the intestines or of the appendix or 
spleen or other organ having connection with the portal cir- 
culation. Enlargement of the spleen is a marked feature. 

5. Hepatitis must be differentiated from pigment liver. 
The latter is due most frequently to malarial poisoning, and 
is marked by extra-hepatic symptoms, such as grave cerebral 
disturbance, albuminuria, hemorrhage from the bowel, profuse 
diarrhoea and enlarged spleen. There is slight jaundice, and 
the fever is often intermittent. 

6. Diaphragmatic pleurisy may resemble hepatitis, or 
more especially perihepatitis. However, the pain of dia- 
phragmatic abscess is more intense than in either of the 
other affections. There is nausea and vomiting, dry cough, 
and the respiration is difficult, often amounting to orthopnoea. 
Jaundice is usually absent. There may be singultus, great 
anxiety, possibly delirium, paroxysmal cough, and the sardonic 
grin. Friction sounds may be detected. 

Often the physical signs are out of all proportion to 
the intense general symptoms. There may be a few fine 
moist rales in the lower part of the lung. The disease usually 
is announced by a chill; there is more or less fever. Usually 
the pain on pressure is located not only over the liver but 
also further towards the sternum, perhaps reaching within 
less than two inches of the linea alba. There is usually most 
tenderness in the region of the tenth rib, at the insertion of 
the diaphragm at this point. It has been claimed that up- 
ward pressure over the liver in these cases relieves the pain, 
which would be a valuable diagnostic point. Often expectora- 
tion is difficult. Pressure on the neck may elicit tenderness, 
and shooting pains may be complained of along the clavicle 
and in the region of the superficial cervical plexus and the 
phrenic nerve of the affected side. As stated, this is elicited 
especially by pressure. 

7. Icterus may be due to a great variety of causes. 
Syphilitic icterus may be hepatogenous or hematogenous. 
Hematogenous syphilitic icterus is ascribed to syphilotoxines. 



110 Diagnosis of Syphilis. 

Hepatogenous syphilitic icterus may be due to gummata, 
syphilides, or to changes caused in the liver by the poisons of 
syphilis. The presence of other symptoms of syphilis may 
help or hinder the diagnosis of syphilitic jaundice. We must 
remember that syphilitics may suffer from non-syphilitic jaun- 
dice, for syphilis confers no immunity against the other causes 
of jaundice. Indeed, the individuals most frequently affected 
with syphilis, are especially liable to other causes of jaundice. 
Vices are gregarious. For instance, syphilitics are often alco- 
holics. The most common cause of jaundice is catarrhal in- 
flammation of the smaller ducts and the common bile duct, 
that is so often found associated with gastro-duodenal catarrh. 

Among the common causes of hepatogenous jaundice are: 
First, gall-stones or inspissated bile in the common duct or 
the radicles of the common duct ; second, malignant new 
growths of the liver, stomach, pyloris, duodenum, pancreas, 
kidney, or secondary infiltration of the glands in the trans- 
verse fissure ; third, gastric or duodenal catarrh ; fourth, abdom- 
inal aneurisym ; fifth, hydatid cysts ; sixth, accumulation of 
feces ; seventh, ovarian or uterine tumors ; eighth, lyinpha- 
denoma; ninth, perihepatitis, and tenth, syphilis (gummata, 
syphilides, cicatricial tissue). 

Hematogenuos jaundice may be caused by: First, yellow 
fever, typhus, scarlet fever, dengue, relapsing fever, pneu- 
monia, and possibly the severe forms of all the infections. 
It occurs in the severe forms of malaria and septicennia. 
Thus, jaundice is sometimes present in acute ulcerative endo- 
carditis, a form of septicemia. Second, there are many toxic 
causes of hematogenous jaundice. Possibly the infections 
might be placed in this class, inasmuch as the jaundice in 
those cases is probably due to the action of toxines. Other 
toxic causes are: snake bite, phosphorus, copper, mercury, an- 
timony, chloroform, ether, poisoning by the coal-tar products, 
chlorate of potassium, and mushroom poisoning. Third, acute 
yellow atrophy of the liver ; fourth, cirrhosis of the liver ( in 
the later stages) ; fifth, various neuroses (joy, grief, fear, and 
passion) ; sixth, icterus neonatorum. 



Diagnosis of Syphilis. Ill 

Icterus neonatorum may be due to syphilis, but it is more 
frequently due to other causes. In the ephemeral cases, that 
clear up in some ten days or two weeks, some ascribe the 
jaundice to a decrease in the blood-pressure; others believe 
it to be due to some mild infection. It is possible that 
both these may be causative factors. The cases due to severe 
infection usually succumb. Among the common severe infec- 
tions are septicemia (umbilical infection) and hereditary syph- 
ilis (especially hepatitis). In the cases due to hepatic dis- 
ease the urine is usually stained with bile and the stools are 
light. Among the rare causes is congenital stenosis or absence 
of the common or hepatic duct. Concussion of the brain has 
been reported to cause jaundice. 

Icterus also sometimes appears in the course of diabetes, 
possibly due to changes in the pancreas, or to some poison cir- 
culating in the blood or eliminated through the liver, or as a 
simple complication. 

In acute yellow atrophy, the early symptoms are those of 
gastro-intestinal catarrh: loss of appetite, nausea, vomiting, 
constipation, pain and tenderness over the liver. Later there 
is jaundice in two-thirds of the cases, beginning in the face 
and gradually extending over the body. Sometimes there is 
an initial rigor. There may be general weakness, pains in the 
muscles, a tremulous tongue, and epistaxis. Later there are 
cardiac asthma and an irregular pulse with increased tension. 
Later marked nervous symptoms supervene — restlessness, de- 
lirium, coma, irregular breathing, which becomes sterterous, 
and the scene is closed by death. The liver, which at first 
may have shown some increase in size, becomes greatly atro- 
phied as a rule. However, death may supervene before there 
is marked atrophy of the liver. Sometimes atrophy of the 
liver can not be detected when there is an accompanying 
hyperplasia of the connective tissue. Hemorrhages occur in 
more than half the cases, usually in the form of hematemesis. 

The early symptoms of acute yellow atrophy are those of 
catarrhal jaundice. The characteristic symptoms begin later; 
severe jaundice, hemorrhage, and nervous symptoms. Leucin 



112 Diagnosis of Syphilis. 

and tyrosin are usually to be found in the urine. The ob- 
jective symptoms, with the decreased hepatic dullness and the 
increased size of the spleen, make the diagnosis clear. 

The chief affection of the liver during the second stage 
of syphilis, is marked by hepatitis and icterus. We have 
already referred to these in connection with hereditary syphilis. 
They also occur during the second stage of the acquired form 
of syphilis. 

More marked are the tertiary syphilitic affections of the 
liver, notably gummata and syphilitic cirrhosis. These are 
much more common in practice than affection of the liver 
during the second stage of syphilis. 

8. Gummata of the liver may be latent or may produce 
various symptoms. Usually the onset is insidious, so that it 
is difficult for the patient to state when the symptoms began. 
It is possible for gummata to develop without disturbing 
either the circulation of the blood or bile. There may be such 
disturbances, due to syphilitic affection of the connective tissue 
and perihepatitis. Usually the first symptoms are emaciation, 
malaise, disturbances of digestion, and pain in the region of 
the liver, slight and dragging, or severe and lancinating. The 
more severe pain is usually indicative of perihepatitis. Physi- 
cal examination reveals an enlarged liver. Perihepatitis may 
cause friction sounds. The enlargement of the liver is ir- 
regular and the organ is often altered in shape. Palpation 
may reveal nodules and depressions, and the liver is firmer 
than normal, sometimes to amount to a woody induration. 
Interference with the circulation and bile may cause ascites, 
the formation of a caput Medusas and the presence of 
jaundice. Death may result from cachexia or from syphilitic 
lesions in other parts of the body, especially the kidneys and 
brain. 

9. Hepatic gummata should be differentiated especially 
from cancer of the liver. The age, history, and associate 
symptoms may be suggestive. Cancer of the liver shows more 
marked jaundice, ascites, and pain. The liver increases more 
rapidly in size, and the nodules are usually larger and firmer 
than in syphilis. 



Diagnosis of Syphilis. 113 

10. Primary tuberculosis of the liver is rare, but sec- 
ondary tuberculosis of the liver is a rather common affection, 
occuring in acute military tuberculosis and also in chronic 
tuberculosis of the lungs and bones. The tubercles are small, 
so that usually they may not be recognized with the naked 
eye. The largest are rarely larger than a pea. Large solitary 
tubercles, that probably may be regarded usually as instances 
of primary infection, may resemble the nodules of cancer or 
gummata. Several cases have been reported in which a car- 
cinoma occurred upon a tubercle in the liver. Large nodules, 
containing cavities the size of a walnut, may result from 
tuberculosis of the bile ducts. Tuberculosis of the liver may 
be acute, subacute, or chronic. The symptoms are usually 
slight, so that they may be overlooked, being overshadowed by 
the miliary tuberculosis or the chronic tuberculosis of the 
lungs or bones with which the liver affection is associated. 
The presence of icterus or the rapid development of a pain- 
less ascites may arouse suspicion. In children the liver may be 
enlarged and sensitive. 

11. Gall-stones will rarely become confused with hepatic 
syphilis. Calculi in the gall-bladder may produce no symp- 
toms. Post-mortems show gall-stones in about one-tenth of 
all cases, most frequently in the female sex. The most ob- 
trusive symptom is pain, gall-stone colic. An over distended 
gall-bladder may be painful. The attack of gall-stone colic 
begins with a feeling of discomfort, which gradually increases 
to absolute, often excruciating pain, in the right hypochon- 
drium or epigastrium. There is interference with digestion, 
sometimes vomiting. Often the patient complains of pain 
at the angle or inner margin of the scapula. There are 
obstipation and tympanites. There is a slight rise of tem- 
perature, 99°-99.5°F. Usually there is no icterus. As a rule, 
gall-stones do not cause colic, except when there is impaction 
of the stones in the cystic duct. When the gall-bladder is 
enlarged it may be felt as a tumor. 

12. Syphilitic cirrhosis may resemble alcoholic cirrhosis of 
the liver, and the differential diagnosis is often further em- 



114 Diagnosis op Syphilis. 

barrassd by the fact that not infrequently syphilitic patients 
are addicted to the use of alcoholic beverages. Alcohol and 
syphilis are frequently companions. Cirrhosis of the liver 
must be differentiated especially from pyelophlebitis, p3'elo- 
thrombosis, thrombosis, hypertrophic cirrhosis, diffuse chronic 
peritonitis, hyperemia, amyloid liver, hepatic carcinoma, and 
the simple atrophy of marasmus. 

The early symptoms of cirrhosis of the liver are those of a 
gastro-intestinal catarrh : eructations of gas, gastric pain, 
coated tongue, nausea and vomiting, and diarrhoea alternating 
with constipation. At first the liver may be larger than 
normal, but with the contraction of the cicatricial tissue the 
liver becomes reduced in size and the surface uneven. There 
is hepatic tenderness and pain radiating toward the right 
shoulder. The patient is pale, emaciated, and experiences 
early fatigue. The symptoms are due chief!}' to the obstruc- 
tion of the portal circulation through the liver. Damming 
back the blood in the gastric vein, this causes morning sick- 
ness, dyspepsia and hematemesis. Engorgement, due to ob- 
struction to the flow of blood through the spleenic vein, is 
marked by pain and some enlargement of the spleen, though 
this may be difficult to detect. Engorgement of the mesenteric 
vein leads to ascites. The obstructed venous circulation, 
through the inferior mesenteric vein, leads to the formation 
of hemorrhoids. The subcutaneous abdominal veins become 
dilated, especially along the margin of the ribs and around 
the umbilicus (the caput Medusae). The urine may at 
first be increased in quantity, but soon becomes scanty, high- 
colored, and of high specific gravity. The reaction is strongly 
acid and urates are present in abundance. The amount of 
urea is decreased ; urobilin and uric acid are increased. There 
are peptonuria, sometimes glycosuria and albuminuria, from 
passive congestion and cachexia. With great diminution in 
the quantity of urine there may be symptoms of toxemia. 
There is more or less jaundice, especially late in the course 
of the disease. Fever may be present in acute cases or may 
be caused by perihepatitis or catarrh of the bile ducts. 



Diagnosis of Syphilis. 115 

The above symptoms are indicative of cirrhosis, either 
of the syphilitic or alcoholic variety. The differentiation 
between these forms of cirrhosis is often difficult. Pain is 
more prominent in syphilitic cirrhosis, being due to affec- 
tion of the peritoneal capsule of the liver. Other symptoms 
of syphilis may help in diagnosis, but it must be remembered 
that syphilitics are not immune from alcoholic cirrhosis. 
Syphilis, like alcohol, must simply be regarded as a promi- 
nent toxic cause of cirrhosis of the liver. 

13. Amyloid disease is due to prolonged suppuration 
in some part of the body. Tuberculosis and syphilis are 
frequent causes. Amyloid liver is usually associated with 
a similar involvement of the spleen, kidneys, and intestines. 
As a rule the liver is enlarged and firm upon pressure, 
and the surface is smooth. The bile is diminished in quan- 
tity and poor in quality, with consequent intestinal dis- 
turbance and tympanites. There are some anemia and 
leucocytosis. Suspicion may be aroused by amyloid disease 
in other organs, especially the spleen, kidneys, or intestine. 
Characteristic of amyloid liver is the great enlargement of 
the liver, with firmness upon pressure, rounded border, free- 
dom from pain or tenderness upon pressure, and the presence 
of a chronic suppuration somewhere in the body. Syphilis 
of the liver, especially perihepatitis, may cause pain or 
tenderness upon pressure. 

Pancreas. 

In hereditary syphilis, congential syphilitic pancreatitis 
has been observed as early as the fifth month. In an 
early report, Birch-Hirschfeld found the disease thirteen times 
in twenty-three cases of congenital syphilis. Later the same 
observer was able to report only twenty-nine instances in 
an additional series of 124 cases. 

In acquired syphilis, there is a wide divergence of 
opinion regarding the frequency of pancreatitis. It is in- 
teresting to note that in a number of cases with a history 



116 Diagnosis op Syphilis. 

of syphilis, the pancreatitis was possibly due to a co-existing 
cancer of the stomach or pancreas. In a number of instances 
gumma and scar tissue have been found in the pancreas. 

Fatty diarrhoea, glycosuria, and epigastric pain would 
be suggestive, especially in the presence of other signs and 
symptoms of syphilis. 

Peritoneum. 

Peritonitis is rare. Occasionally a localized peritonitis 
may be caused by syphilis of the liver, intestine or spleen. 
Still more rare is general peritonitis, though this may result 
from syphilis of the intestine, especially of the small intestine, 
with or without perforation. 

RECTUM AND ANUS. 

Too strong emphasis cannot be placed on the importance 
of examinations for the spirochete pallida and the Wasser- 
mann reaction. While these diagnostic factors do not elimi- 
nate the possibility of non-syphilitic affections, they may 
be relied upon in making a diagnosis of syphilis. We must 
then decide whether the patient's syphilis is responsible for 
the lesion that confronts us. A negative examination for 
the spirochete pallida or the Wassermann reaction, does not 
necessarily imply that the disease is not syphilis. 

Syphilis most frequently affects the two extremities of 
the alimentary tract. All stages of the disease may be 
represented in affections of the rectum and anus. Hence 
the importance of using proper precautions, such as the 
protection of the hands by rubber gloves when making rectal 
examinations. 

1. Syphilis of the rectum: (a) chancre; (b) syphilide; 
(c) Gumma. 

2. Cancer of the rectum. 

3. Rectal tuberculosis. 



Diagnosis op Syphilis. 117 

4. Fistulae. 

5. Rectal abscess. 

6. Hemorrhoids. 

7. Prolapse. 

8. Polypi. 

9. Pruritus. 

10. Ulcer and fissure. 

11. Stricture. 

12. Rodent ulcer. 

13. Fecal impaction. 

14. Villous tumor. 

15. Neuralgia. 

16. Sacro-coccygeal arthralgia. 

17. Proctitis. 

1. a. The primary syphilitic sore may occur in this 
region through unnatural intercourse or through infection 
by contact with anything that is contaminated with the 
syphilitic virus. Possibly there is no more dangerous habit 
than the common use of syringes. Nowadays no physician 
would think of using a rectal speculum that had not been 
sterilized. The same precaution should be extended to the 
common syringe. 

The indurated chancre may break down, to form a 
painful fissured ulcer. Later, especially in the anal ring, 
there may be contraction that is obtrusive. 

1. b. The second stage of syphilis is more frequent 
in the rectum and anus. The syphilides, however, usually 
do not cause annoyance. Indeed, this seems to be one of 
the characteristics of the lesion in this region. Sometimes 
there may be tenesmus and a discharge of mucus and pus. 
On the other hand, even a bleeding, ulcerated papule may 
cause little or no discomfort. Frequently there is a distinct 
separation between the papules of the anus and those situated 
higher up in the rectum. 

1. c. The third stage of syphilis is the one that most 
frequently involves the rectum and anus. Gummata often 



118 Diagnosis of Syphilis. 

occur in this locality and frequently lead to ulceration. In 
diagnosis, differentiation from cancer is important. Mathews 
has stated that in cancer of the colon there is frequently 
diarrhoea, whereas in syphilis of the colon there is more 
often constipation. Syphilis of the rectum and anus is 
more frequent in women than men. As compared with 
cancer, rectal gummata are of much slower growth. 

The irritation of an ulceration may cause watery, bloody 
stools, the presence of tenesmus and the loss of the abdominal 
sensation resulting in the involuntary discharge of the feces. 
Digital examination might arouse the suspicion of an ulcer, 
because of the puffiness and irregularities of the mucous 
membrane. The diagnosis of ulcer would be made absolute 
by the use of the proctoscope. 

The breaking down of gummata in the perirectal tissue 
may lead to perforation into the rectum or vagina or ex- 
ternally to constitute a fistula. In this way there may be 
formed rectoperineal and rectovaginal fistula 1 . 

Sometimes the anorectal syphiloma (Fournier) takes the 
form of a syphilitic callosity, an anorectal infiltration with 
the formation of cicatricial tissue that contracts and thereby 
reduces the size of the lumen of the rectum. This process 
usually does not affect the region of the sphincter. The 
rectum, however, may be converted into a narrow tube, 
with the consequent symptoms of stricture. 

Syphilis not infrequently causes stricture of the rectum 
or anus ; but not every rectal or anal stricture is syphilitic. 

2. Cancer of the rectum is comparatively rare before 
the age of thirty-five ; and men are more frequently affected, 
in the proportion of six to five. The early symptoms of 
cancer of the rectum are a feeling of weight and heaviness 
in the pelvis and more or less ill defined annoyance at the 
time of defecation and immediately after. Later the annoy- 
ance becomes actual pain. The stools become altered ; there 
is alternating constipation and diarrhoea. The passages con- 
tain mucus, pus, sometimes blood. Depending largely upon 
the extent of the disease, and more especially upon the 



Diagnosis of Syphilis. 119 

location of the destructive process, there may be loss of 
sphincter control. All of these symptoms may be slight 
until the cancer is pretty well advanced, and they may all 
be present in syphilis and other diseases of the rectum. 
Emaciation and cachexia may be observed in syphilis, but 
they usually are more marked and occur earlier in cancer. 
It is important to make the diagnosis before these symptoms 
are present, since any operative work for the cure of cancer 
must be done early. 

In the differentiation from cancer, great importance must 
be attached to the physical examination. This will frequently 
test the acumen of the diagnostician. Cases may frequently 
be cleared up by the mircoscopic examination of particles 
of the diseased tissue, which may be readily removed through 
the proctoscope. 

In syphilis, as well as in dysenteric and simple ulcer, 
there is comparatively slight induration, the edges of the 
ulceration are usually soft and flexible, and the general 
contour of the mass is more regular than in cancer, which 
usually shows more marked induration and hard, irregular 
borders, the induration extending beyond the edges of the 
ulcer and gradually fading into the surrounding tissues. It 
is difficult to describe the differential diagnosis by palpation, 
since there are so many variations in both diseases, and 
often the judgment must be based upon comparative findings. 
This is especially true in the early differentiation between 
syphilis and cancer of the rectum. In these cases the 
microscopic examination of the affected tissue is often of 
very great value. Above all, we must recognize and impress 
upon our patients the importance of making the diagnosis 
early, when there is a suspicion of cancer. To this end, 
we should not hesitate to make a rectal examination in such 
cases, especially after the age of thirty-five. 

3. At times it becomes necessary to differentiate be- 
tween syphilitic and tubercular affection of the anus and 
rectum, especially in the presence of fistulae. In difficult 
cases the search for the tubercle bacillus and the use of 



120 Diagnosis of Syphilis. 

the therapeutic test for syphilis assume importance. The 
tuberculin test is also of value in these cases. Tuberculosis 
of the rectum must be regarded as very rare in the absence 
of pulmonary tuberculosis. On the other hand, syphilis 
and tuberculosis may co-exist. I have seen a case in which 
both diseases involved the rectum. 

4. Rectal fistulae may be external (complete) or internal 
(blind). As stated, they may be due to the breaking down 
of gummata. More frequently they are tubercular. They 
are more frequent in men than in women. Trauma seems 
to play an important role in etiology. Sometimes they 
result from abscess. Other etiological factors are injury 
by foreign bodies that have been swallowed, or by kicking, 
falling or other form of trauma. They occur especially in 
individuals of low resistance, especially in the presence of 
a vitiated condition of the blood. The degree and character 
of pain varies, being acute in the cases due to the rapid 
formation of abscesses, and little in the syphilitic or the 
simple tubercular fistula, unless the fistula involves the sphincter 
muscle, or becomes closed and filled with the pus. Usually 
the discharge is thin and watery, but it may be purulent, 
sometimes tinged with blood, possibly fecal. It may or 
ma}' not be possible to detect an external opening. The 
sinus may be felt as an indurated cord or mass, usually 
running a tortuous course. May be single or multiple. The 
internal opening is usually between the two sphincters, but 
it may be difficult to detect. It has been stated that in 
tuberculous fistula? the external and internal openings are 
large, but this is not an invariable characteristic. The 
same remark holds good concerning the statement that in 
phthisis the hair around the anus is long and silky. Such 
a condition is often present late in phthisis, but is found 
in other cases and is usually not to be observed during 
the early stages of tuberculosis. 

5. Rectal abscess may be acute or chronic. Clinically 
we may consider as abscesses, cavities that are filled with 
either pus or broken down tissues. The latter are the so- 



Diagnosis of Syphilis. 121 

called cold abscesses. The pain is sharp and lancinating 
in acute abscess. So-called cold abscess may cause only 
a sense of discomfort rather than actual pain. The pus 
is thick in acute abscesses; thin and watery in "cold" ab- 
scesses. The "cold" abscesses are almost invariably tubercular. 
There is constipation, because defecation is painful. At 
first palpation will detect a mass, due to inflammatory exuda- 
tion; later there is a collection of pus. In acute abscess, 
palpation will detect increased heat and elicit pain. The 
"cold" abscesses show fluctuation. Not infrequently these 
abscesses empty into the bowel. Preceding the rupture 
of the abscess into the bowel the patient will experience a 
sense of weight and pain, and rectal examination will reveal 
tenderness, and irritability of the sphincter. Acute abscess 
is marked by high temperature and rapid pulse. "Cold" 
abscess may be accompanied by a normal or subnormal tem- 
perature, and feeble low pulse. 

6. Hemorrhoids may occasionally enter into the question 
of differential diagnosis, especially when inflamed and ulcer- 
ated. Hemorrhoids may be external or internal. The external 
hemorrhoids may be either simple skin enlargements or venous 
tumors. The internal hemorrhoids may be large or small, 
and they may or may not be hemorrhagic. Among the 
causes of inflammation of external hemorrhoids are irritation 
from friction, cold, diarrhoea, dysentery, excesses in venery, 
alcohol, smoking, straining at stool, and obstruction of the 
venous circulation. The internal hemorrhoids are almost 
invariably just within the sphincter, and may be readily 
recognized upon rectal examination. The external hemorrhoids 
not infrequently cause pain, through affection of the 
sphincter. Internal hemorrhoids are seldom marked by pain, 
save in the presence of inflammation or some complication. 
External hemorrhoids are usually not marked by discharge, 
save possibly some blood and mucus, if the surface is broken. 
The small internal hemorrhoids often bleed ; the larger ones 
are characterized rather by the discharge of mucus. In 
hemorrhoids there may be either constipation or diarrhoea, 



122 Diagnosis of Syphilis. 

and not infrequently there is constipation alternating with 
diarrhoea. Externa] hemorrhoids may appear as simple tags 
of skin, often inflamed, or as a dark bluish tumor. The 
internal hemorrhoids are usually lighter in color, and when 
they protrude through the sphincter they may be readily 
returned. Often the internal hemorrhoids cannot be detected 
by the sense of touch, when in the bowel, unless they are in- 
flamed. The patient with external hemorrhoids complains 
of pain and the presence of a tumor, frequently with pain 
in walking and at stool. Internal hemorrhoids cause more 
indefinite symptoms, such as pain in the back and thighs, 
loss of energy, and possibly mental anxiety. These patients 
not infrequently fear that they have cancer. The sphincter 
is usually contracted in j'outh and relaxed in the aged. 

7. Prolapse of the rectum is not a very common affection. 
It is more frequent in children, often apparently due to 
intestinal parasites, especially thread worms. A diminished 
sacral curve has been declared to be a cause. There is very 
little pain, unless there is strangulation. There is a dis- 
charge of mucus, possibly tinged with blood. Generally 
there is diarrhoea. Excessive diarrhoea sometimes is a causative 
factor. The prolapsed tissue protrudes as a soft, velvety 
mass, entirely surrounding the anus. The patient may 
complain of a burning sensation. 

8. Polypi have sometimes been mistaken for syphilis, 
but more frequently for cancer, especially when inflamed 
and ulcerated. Examination will reveal a tumor attached 
to a pedicle. When the polypus protrudes past the sphincter, 
the patient will experience some pain. The mass is easily 
replaced. The discharge consists of mucus, sometimes blood. 
Diarrhoea is more common than constipation. A protruding 
polypus may resemble a berry in appearance, and may be 
hard or soft to the touch. It is distinguished from other 
tumors by the fact that it is attached to a pedicle. They 
are most frequently mistaken for piles. 

9. Pruritus may at times be confused with syphilis, 
especially condyloma. Pruritus is aggravated by discharges. 



Diagnosis op Syphilis. 123 

The patient complains of a burning sensation rather than 
actual pain. There is usually more or less laceration of the 
skin, due to scratching for the relief of itching. The anal 
folds may be roughened, and the pruritus may extend to the 
scrotum and buttocks. The margin of the rectal mucous mem- 
brane is reddened and irritated, and the itching often extends 
up into the rectum. At times pruritus may bear some resem- 
blance to eczema, and there may be a weeping surface. There 
is often increased pigmentation. 

10. Rectal ulcer and fissure are comparatively common 
affections, and are due to many things beside syphilis. There 
is practically no difference in the frequency of affection of 
the sexes. The most common cause is trauma, anything 
that will tear or cause a lesion of the rectal mucous mem- 
brane. Rectal ulcer is located above the sphincter but within 
its grasp. Pain is out of all proportion to the lesion, 
beginning perhaps twenty minutes after defecation and last- 
ing for hours. There is often no discharge, but usually 
there is a discharge of mucus tinged with blood. Painful 
defecation leads to constipation. Examination of the anus 
will often reveal a swollen tag of skin, that appears as 
a small white tumor. The ulcer is higher up, and can 
be readily inspected with the speculum, a red and inflamed 
ulcer on or above the sphincter. A fissure may extend 
down to the anus. The dorsal portion of the rectum is most 
frequently affected, though no part is exempt. There may 
be symptoms on the part of the bladder, prostate and urethra. 

11. Stricture of the rectum may be simple or accom- 
panied by ulceration. Syphilis is the most common cause 
of the ulcerated strictures. Cancer is another prominent 
cause. Other etiological factors are traumatism and long 
continued pressure. Simple stricture of the rectum in females 
is often due to pressure of the uterus. There is little or 
no pain, but rather a feeling of weight in the rectum. There 
may be diarrhoea or constipation. Often there is alternating 
constipation and diarrhoea. There may be no discharge. 
A mucous discharge may be present in simple stricture and 



124 Diagnosis op Syphilis. 

is the rule in ulcerated stricture, becoming later muco- 
purulent. There is not much blood. There are no external 
signs, save in the presence of fistula or pruritus. Simple 
stricture can be felt digitally as an annular constriction, 
often like a cord extending around the bowel. In ulcerated 
stricture there is ulceration above and below the stricture. 
The stricture is hard and fibrous but not nodular. Nodules 
would speak rather for cancer. Constipation characterized 
by chronicity is often due to simple stricture. The syphilitic 
ulcerated stricture begins usually as a gumma, and the patient 
often seeks advice first because of constipation or diarrhoea. 

12. Rodent ulcer may resemble syphilis. It is a com- 
paratively rare disease. Pain is caused by ulceration. There 
is a slight discharge of blood and mucus. Diarrhoea. Nothing 
may be found externally, but examination of the interior of 
the rectum reveals a large ragged ulcer, irregular and sensi- 
tive to the touch. 

13. Fecal impaction is due to loss of tone of the muscles 
in the intestinal wall, and is found most frequently in the 
aged. There is indistinct pain, described usually as a dull 
heavy pressure at the anus. There may be severe reflex 
pain. Discharge is usually absent, save in the presence of 
ulceration. There is usually the diarrhoea of constipation. 
Usually nothing may be observed externally. Some have de- 
scribed a nipple-shaped anus. Examination shows a hard 
doughy mass above the sphincter. There may be considerable 
general disturbance in these cases, such as indigestion, loss 
of flesh, possibly night-sweats. 

14. Villous tumor is rare. There is little pain. There 
is a discharge of mucus, and especially of blood. These 
tumors may cause diarrhoea to present the picture of a 
dysentery. Sometimes these tumors descend so as to be 
visible externally. Examination with the speculum reveals 
the characteristic villous tumor. These bleed freely and 
may or may not be attached by a pedicle. There is often 
anemia due to the loss of blood. 

15. The chief characteristic of neuralgia is pain, gnaw- 



Diagnosis of Syphilis. 125 

ing, teasing and distressing in character. Any discharge 
is due to ulceration or some organic lesion. Bowels may 
be normal. Rectal neuralgia is comparatively rare, and 
effects especially the nervous and irritable, though the robust 
are not exempt. 

16. Sacro-coccygeal arthralgia may be neuralgic or 
rheumatic. Pain is constant and is not usually relieved 
by any position the patient may assume. No discharge. 
The diagnosis is made by digital examination. Trauma and 
child-birth are prominent causes. 

17. Proctitis may be due to any of the numerous causes 
of inflammation. There is a dull, heavy pain in the rectum. 
Reflected pain may be experienced in other organs and in 
the back and thighs. The discharge may be bloody or 
mucous or muco-purulent. There is diarrhoea, often dysenteric 
in character. The diagnosis is made by rectal examination. 



SYPHILITIC AFFECTIONS OF THE RESPIRA- 
TORY ORGANS. 

Nose. 

All stages of syphilis may affect the nose. The first 
stage is represented by the chancre, which may be found 
upon the tip or ala of the nose. "Cases have also been reported 
in which the chancre has been found in the interior of the 
nose, the naso-pharynx and upon the septum. Usually there 
is enlargement of the submaxillary glands; less frequently 
the preauricular glands are affected. In the reported cases, 
the finger has generally been the medium of infection. A 
number of cases have resulted from the use of contaminated 
handkerchiefs and towels. The danger of using unclean 
instruments is not to be lost sight of. Infection has been 
conveyed by the eustachian catheter.,- Syphilitics should be 
instructed not to lend their atomizers, when these are pre- 
scribed. In general, the syphilitic patient should be impressed 



126 Diagnosis of Syphilis. 

with the contagious character of his malady. In doubtful 
cases, the therapeutic test for syphilis and the microscopic 
examination of the affected tissue is justifiable, in order 
to make an early differentiation from cancer and tuberculosis. 
Usually an examination for the spirochete pallida and the 
Wassermann reaction will determine whether or not the 
patient is a syphilitic. 

The second stage of syphilis frequently involves the 
nose, but is often overlooked because it usually does not 
cause much inconvenience. All the various secondary erup- 
tions of the skin and mucous membrane may be represented 
in the nose. These patients frequently suffer from "colds," 
coryza. Indeed, a nasal catarrh is not infrequent during 
the first stage of syphilis. During the second stage, catarrh 
and ulceration of the nasal mucous membrane may often 
be found. The coryza of syphilis is not always a symptom 
of iodism. But usually the nasal symptoms of the second 
stage of syphilis are comparatively mild. The ulcerations 
of the nasal mucous membrane during this stage are usually 
superficial. 

In the nose, the third stage of syphilis is most important. 
The sunken bridge of the nose is a prominent sign of syphilis. 
Gummata may occur in any part of the nose. These may 
block the nose and lead to extensive destruction of tissue 
and deformity. Gumma of the skin has already been de- 
scribed. Gumma of the skin of the nose may cause destruc- 
tion of the skin and also of the underlying cartilage and 
bone. The same is true of the mucous membrane. Gumma 
of the mucous membrane may lead to destructive changes 
in the cartilage and bone. On the other hand, it is remarka- 
ble what large ulcers will sometimes result from the breaking 
down of gummata without destruction of the cartilage or 
bone of the nose. The cartilage and bone are much more 
liable to damage in gumma of the mucous meembrane than 
in gumma of the skin. Gumma occurring primarily in the 
cartilage or bone is regarded as rare. Of the cartilage of 
the nose, the cartilaginous septum is most frequently affected 



Diagnosis op Syphilis. 127 

by the ulceration of gummata, often with consequent per- 
foration of the septum. Less frequently there is destruction 
of the ala or tip of the nose. Gumma may also lead to 
perforation of the palate. Perforation of the roof of the 
nose, externally, is more rare. The ulceration and destruction 
of bone occur with especial frequency during the tertiary 
syphilitic affections of the nose. Gumma of the nasal bones 
frequently leads to necrosis. So it is not strange that the 
third stage of syphilis is often marked by an intractible 
rhinitis, that may persist for months or years. Sometimes 
the gumma produces pain. The more marked symptoms, as 
a rule, are the obstruction to breathing, the rhinitis, and 
the destructive processes. It is interesting to note that de- 
struction of the bone has been, observed as early as the seventh 
month of syphilis. At times ozena is a conspicuous symptom 
of syphilis. Great destruction of bone may occur without 
marked external deformity. On the other hand, sinking of 
the bridge of the nose may be caused by destruction of the 
perpendicular plate of the ethmoid bone and the subsequent 
contraction of cicatricial tissue. Further deformity may be 
caused by destructive changes involving the vomar and the 
cartilaginous septum, when the entire nose appears sunken 
through the subsequent contraction of the cicatricial tissue. 
The contraction of cicatricial tissue probably plays an im- 
portant role, for it is remarkable what great destruction of 
tissue may occur without external deformity 

Not every ozena is syphilitic. But syphilis may produce 
a marked ozena, ozena syphilitica, due to a rhinitis syphilitica 
necrotica or atrophica. The French call the condition punaisie, 
comparing the odor to that of a crushed bedbug (punaise). 
Frequently these patients do not, themselves, perceive the 
odor of their ozena, while at the same time they may or 
may not be able to recognize other odors. 

The differential diagnosis has to do chiefly with tuber- 
culosis, especially lupus ; rhinoscleroma, and carcinoma. Lupus 
usually occurs at an earlier age than acquired syphilis, but 
syphilis may occur at any age. The diagnosis of tuberculosis 



128 Diagnosis of Syphilis. 

rests upon the demonstration of the bacillus in the discharge 
or in the growth. There may be tuberculosis elsewhere, espe- 
cially in the lungs, larynx, mouth, tongue, or pharynx. 
Lupus presents a history different from that of syphilis, 
and is often accompanied by cutaneous lupus. The growth 
is slow. The nodular character of the lupus lesion, and its 
manner of spreading at the circumference and cicatrizing in 
the center, are characteristic. Rhinoscleroma is rare in 
this country. Recognition depends upon finding the bacillus 
of rhinoscleroma. The affection is confined to the nose, 
and is characterized by hardness, sharp outlines, slow develop- 
ment, absence of adjacent inflammation and of constitutional 
symptoms. Pain is absent. The diagnosis of carcinoma is 
made absolute by the histological examination of the growth. 
The specimen of tissue taken for microscopic examination, 
should extend from the diseased into the apparently healthy 
tissue. In cases of carcinoma, the Wassermann reaction is 
negative, except when the patient is a syphilitic. There 
is pain, sometimes lancinating in character. Early in the 
course of the affection, the lymphatic enlargement is slight 
compared to that observed in syphilis. The course of the 
disease is very different from that of syphilis. 

Doubtful cases may be cleared up by the Wassermann 
reaction, the therapeutic test for syphilis, and the microscopic 
examination of the affected tissue. 

Ozena may be due to simple atrophic rhinitis. Often 
there is a history of preceding hypertrophic rhinitis. Exami- 
nation reveals the mucous membrane thinned, often covered 
with crusts. Ulcers are not common. There is cirrhotic 
atrophy of the erectile tissue. 

Among the rare causes of ozena are glanders and leprosy. 
The diagnosis of glanders is made absolute by finding the 
bacillus mallei. The mallein test, when carefully made, 
is of value. A history of exposure to inoculation may aid 
in diagnosis. The general symptoms are marked by their 
severity, far exceeding those commonly observed in syphilis. 
Leprosy usually presents antecedent affection of other parts 



Diagnosis of Syphilis. 129 

of the body, the nasal affection being secondary to the 
cutaneous and general invasion. The bacillus lepras makes 
the diagnosis, but is difficult to detect in the tissue. In 
these affections (glanders and leprosy), the spirochete pal- 
lida and the Wassermann reaction are absent, except in 
syphilitics. 

Rhinitis. 

Differential diagnosis may call for the recognition of: 

1. Syphilis: a, chancre; b, syphilides; c, gumma. 

2. The common "colds." 

3. Toxic rhinitis, especially iodism. 

4. Rhinitis of the acute infections and constitutional 
diseases. 

5. Membranous rhinitis. 

6. Hay fever. 

7. Occupation rhinitis, due to dust and vapors. 

8. Phlegmonous rhinitis. 

9. Acute edematous rhinitis. 
10. Ulcerative rhinitis. 

1. In hereditary syphilis, inability to nurse is sometimes 
referred to as a symptom of syphilitic rhinitis. This symp- 
tom is also present in simple rhinitis. In syphilitic rhinitis 
there may be the history or evidence of syphilis in one or 
both parents. Such history or evidence is not essential in 
simple acute rhinitis. In syphilitic cases the child is ill 
developed, small, shriveled, and presents the senile appearance. 
The skin is sallow and unhealthy in appearance. There are 
various other syphilitic lesions, such as condylomata, mucous 
patches, skin eruptions, copper colored blotches, onychia, 
alopecia or brittle hair that has lost its luster, enlargements 
of the bones, and possibly subcutaneous hemorrhages. The 
liver and spleen are enlarged. The voice is often described 
as characteristic. At any rate, the voice is feeble and the 
child does not seem as happy as a normal child, and is 
fretful and wakeful at night. Nutrition is impaired. There 



130 Diagnosis op Syphilis. 

is a painless enlargement of the lymphatic glands, most 
readily recognized in the cervical, submaxillary, inguinal and 
axillary regions. Usually there is no fever. The course 
of the disease is characteristic. There is a tendency to ulcera- 
tion of the mucous membrane, cartilage and bone, with flat- 
tening of the nose. The discharge is purulent, contains shreds 
of necrotic tissue, is offensive and often streaked with blood. 
The alffi present fissures and ulcers. 

In simple acute rhinitis there is no characteristic eruption, 
the associate symptoms of syphilis are absent, the liver and 
spleen are not enlarged, and the child is more normal in 
appearance. There may be some disturbance of sleep, but 
this is not so marked as in syphilis. There is little or no 
impairment of nutrition. There is no general enlargement 
of the lymphatic glands ; the maxillary glands may be en- 
larged and painful, but this is not usual. At first there 
is slight fever, and the affection runs an irregular course. 
The inflammation of the mucous membrane soon terminates 
without ulceration or flattening of the nose. There is a 
discharge, but it is rarely or never markedly purulent; it 
is not offensive and rarely streaked with blood. There are 
not the fissures and ulcers of the alae, nor the formation 
of crusts such as we find in syphilis. 

Chancre and gumma are accompanied by rhinitis, when 
these occur in the nose, but in those cases the rhinitis is 
overshadowed by the essential lesion, chancre or gumma. 

2. Syphilitic patients not infrequently come to us with a 
syphilitic rhinitis, under the impression that they have an acute 
"cold." The acute "colds" run a short course and respond 
to simple remedies, whereas syphilitic rhinitis is more obstinate 
to these remedies and responds readily to antisyphilitic 
treatment. 

3. A toxic rhinitis will sometimes prove interesting, from 
a differential diagnostic standpoint, especially when such a 
rhinitis occurs in a syphilitic. This not infrequently occurs 
when we are pushing the iodides. Bromism is also frequently 



Diagnosis of Syphilis. 131 

encountered. These cases of toxic rhinitis improve readily 
upon the discontinuance of the offending drug. 

4. Rhinitis is present in a number of infections and 
constitutional diseases, notably : 

Measles, whooping-cough, scarlet fever, small-pox, typhoid 
fever, diphtheria, tuberculosis, diabetes mellitus, erysipelas, 
scurvy, influenza, and rheumatism. 

To this list may be added the rare cases of caseous rhinitis. 
Syphilis, of course, is a prominent cause of rhinitis, but we 
must not forget that rhinitis may be due to many other 
causes, and that these causes may be active both in the 
syphilitic and the non-syphilitic. Thus, rheumatism and 
asthma are often prominent causes of rhinitis. Differential 
diagnosis may demand the recognition of these various diseases. 

5. Membranous rhinitis may be due to nasal diphtheria. 
In cases of doubt it is safer to consider such cases diphtheria 
until the diagnosis is clear. The differentiation is made by 
examination for the bacillus diphtherias. There are marked, 
usually severe, constitutional symptoms. The source of in- 
fection may not always be known. The affection of the 
nose is rarely primary, being usually secondary to affection 
of the pharynx, fauces or soft palate. Albuminuria is the 
rule. The cervical glands are enlarged. The membrane is 
grayish or dirty white in appearance, involves the deeper 
layer of the mucous membrane, is closely adherent, and leaves 
a bleeding surface when removed. There may be ulceration 
and a subsequent scar. The nasal discharge is fetid. Some- 
times the condition becomes chronic. There may be subse- 
quent paralysis, especially of the soft palate. Prefers youth 
and early adolescence. 

Sporadic cases of membranous rhinitis are met with, that 
are due to neither diphtheria nor syphilis. Such a croupous 
rhinitis will present mild constitutional symptoms. The affec- 
tion of the nose is usually primary, and the affection remains 
limited to the nose. There is no albuminuria, no enlargement 
of the cervical glands, and the affection of the mucous mem- 



132 Diagnosis of Syphilis. 

brane is superficial. The membrane is readily detached with- 
out bleeding (as a rule), and there is no ulcer nor subsequent 
scar. The membrane is lighter in color than in diphtheria. 
The discharge is not especially fetid. These cases may occur 
at any age and may become chronic. There is no subse- 
quent paralysis. 

6. Hay fever is marked by severe stubborn rhinitis. The 
nasal mucous membrane is hyperesthetic. Diagnosis may be 
aided by a knowledge of the periodicity of the attacks, and 
possibly by finding the exciting cause of the condition. 

7. Occupation rhinitis occurs especially in those exposed 
to dust and irritating vapors, such as chlorin, ammonia, iodin, 
bromin, etc. It is found especially in those predisposed by 
occupation to pneumonokoniosis, such as millers, coal miners, 
wood-carvers, brush makers, weavers, hat makers, individuals 
who are exposed to a dusty atmosphere. It may be caused 
by the fumes of bichromate of potassium, mercury, arsenious 
acid, and osmic acid. Hay fever might be included under 
this class, since irritation by the pollen of plants is a promi- 
nent factor in that disease. However, it is probable that hay 
fever is due to some microorganism that grows upon the 
pollen of certain plants. The possibility of an occupation 
or a traumatic rhinitis should be considered when making a 
diagnosis of syphilitic rhinitis. 

8. Phlegmonous rhinitis presents a localized swelling, 
usually on one or both sides of the septum. It runs the 
course of an acute abscess. 

9. Acute edematous rhinitis may be caused by the inhala- 
tion of steam, irritating fumes, or anything that may cause 
a sudden change in the vascularity of the tissue and conse- 
quent watery infiltration, such as injuries of the mucous 
membrane or the bony framework of the nose. In such 
cases, a knowledge of the cause may be an aid in differential 
diagnosis. 

10. Ulcerative rhinitis deserves separate consideration, 
since nasal ulcer is frequently due to syphilis. 



Diagnosis of Syphilis. 133 

Chronic rhinitis may be due to: 

1. Syphilis. 9. Intumescent rhinitis. 

2. Tuberculosis. 10. Hyperplastic rhinitis. 

3. Glanders. 11. Ozena. 

4. Leprosy. 12. Atrophic rhinitis. 

5. Actinomycosis. 13. Purulent rhinitis. 

6. Rhinoscleroma. 14. Nasal hydrorrhcea. 

7. Cancer. 15. Edematous rhinitis. 

8. Simple chronic rhinitis. 

1. All stages of syphilis may be represented by lesions 
in the nose. Chancre is rare, and for this reason is often 
not recognized as syphilitic until the appearance of the later 
symptoms of the disease. At times the history is of value 
in making a diagnosis ; again, it may be doubtful or unre- 
liable, so as to obscure the diagnosis. Taking into consi- 
deration the appearance of the lesion, and the presence of 
indolent buboes in the neighboring lymphatics, we may arrive 
at a diagnosis by exclusion. Suspicious cases may be cleared 
of by finding the spirochete pallida. 

Nasal syphilides are often overlooked. Macular syphilides 
may cause only slight disturbance. The papular and pust- 
ular syphilides are often accompanied by ulceration and 
marked symptoms. In any case, there may be the history 
of infection, the evidence or history of a primary lesion, and 
the presence of syphilides in other parts of the body, to- 
gether with constitutional symptoms. In doubtful cases, a 
positive reaction to the therapeutic test is one of the most 
valuable points in diagnosis. 

We have described the tertiary syphilitic lesions that are 
found in the nose. The history of the case, the presence or 
evidence of other syplulitic lesions, the necrotic character 
of the nasal lesions, the odor, and the response to the iodides 
are valuable points in diagnosis. However, it should not 
be forgotten that a syphilitic patient is not immune to other 
diseases. 

Rhinitis is one of the most important symptoms of heredi- 



134 Diagnosis of Syphilis. 

tary syphilis. The presence of "snuffles," the history or 
evidence of syphilis in one or both parents, the senile ap- 
pearance of the child, the presence of other syphilitic lesions, 
and the response to anti-syphilitic treatment are useful diag- 
nostic points. 

Hereditary syphilis may later cause symptoms similar to 
those of the third stage in acquired syphilis. There is marked 
destruction of tissue and deformity of the nose, offensive 
odor, the presence or evidence of other syphilitic lesions and 
the response to anti-syphilitic treatment. Lupus must some- 
times be considered in differential diagnosis. 

2. Infection by the tubercle bacillus may cause ulcers, 
or tumors composed of masses of tubercles, or the clinical 
picture known as lupus. The tubercular ulcer will be referred 
to later. Nasal tuberculosis is comparatively rare, is always 
due to the tubercle bacillus, and occurs almost exclusively 
in the presence of pulmonary tuberculosis, and frequently 
in association with tubercular lesions in the mouth, tongue, 
pharynx or larynx. The histor} r of syphilis and tuberculosis 
are entirely different. However, syphilitics may have tuber- 
culosis, and tubercular patients are not exempt from syphilis. 
A positive diagnosis may be made by finding the tubercle 
bacillus in the affected tissue. Aside from syphilis, differential 
diagnosis has to do chiefly with cancer, which is marked 
by a more rapid course and greater pain. Usually tuber- 
culosis occurs at an earlier age than cancer. 

Lupus of the interior of the nose usually occurs in asso- 
ciation with a similar affection of the exterior of the nose. 
The affection is marked by its chronicity, the presence of 
small elevated nodules that tend to spread, coalesce, and ulcer- 
ate. Sometimes absorption takes place and there is subse- 
quent atrophy. Lupus is not characterized by the history 
of syphilis, nor by the presence of syphilitic lesions, and it 
is not influenced by anti-syphilitic treatment. The disease 
must be differentiated also from cancer, which runs a more 
rapid and painful course, and usually occurs later in life. 



Diagnosis of Syphilis. 135 

The ordinary nasal polypi will cause little difficulty in 
diagnosis. 

3. Glanders is a comparatively rare disease in man. In- 
fection by the bacillus mallei occurs almost exclusively in 
those who associate intimately with horses. There are severe 
constitutional symptoms, and the presence of granulation 
tumors in the mucous membrane, which tend to rapid ulcera- 
tion and cause an offensive discharge. A positive diagnosis 
may be made by finding the bacillus mallei. Usually there 
is a reaction to mallein, similar to the reaction to tuberculin 
in tuberculosis. The diagnosis is not difficult to make if 
the disease is suspected. There are more marked constitutional 
symptoms than are characteristic of syphilis, and the disease 
does not respond to the therapeutic test for syphilis. Typhoid 
fever may at times be thought of, but the other symptoms 
of that disease are lacking. It should also be differentiated 
from septicemia and cancer. 

4. Leprosy is a rare disease with us, but it is increasing 
in frequency in this country. In the nose, it may at times 
resemble tertiary syphilis, but the history and course are 
different. Usually there are preceding cutaneous and systemic 
symptoms of the disease. The demonstration of the bacillus 
lepras in the affected tissue would make the diagnosis positive. 
Leprosy should be differentiated from syphilis, and also from 
iodism, morphcea, sarcoma, molluscum fibrosum, lichen planus, 
dysidrosis and Morvan's disease (if this be not, indeed, a va- 
riety of leprosy, or leprosy a causative factor of Morvan's dis- 
ease). The history of the possibility of infection may be of 
value in diagnosis. But usually the disease has lasted several 
years before the nose is affected. There may be extensive le- 
sions, ulceration and absorption of bone, with little or no pain, 
especially in the anesthetic form of leprosy. There is the 
offensive discharge, in these cases, such as is observed in 
the presence of destructive syphilitic lesions of the nose. 

5. Actinomycosis has probably not been reported in the 
nose. But it has been observed in other parts of the upper 
respiratory tract, and the possibility of it occurring in the 



136 Diagnosis of Syphilis. 

nose should not be overlooked. The diagnosis would be made 
by finding the ray fungus. 

6- Rh'moscleroma is comparatively rare with us. A 
positive diagnosis may be found by demonstrating the bacillus 
of rhinoscleroma in the affected tissue. The disease is char- 
acterized by the deposition of hard nodules in the submucosa 
of the mucous membrane and the deeper layers of the skin. 
Like syphilitic lesions, rhinoscleroma is comparatively pain- 
less. There is little or no discharge, and ulceration is rare. 
The disease runs an extremely slow course, and constitutional 
symptoms are lacking. There is not the history of syphilis, 
and rhinoscleroma does not respond to anti-syphilitic treat- 
ment. Epithelioma runs a more rapid course, and is more 
prone to bleed, soften and ulcerate. Keloid may often be 
differentiated only by a search for the bacillus of 
rhinoscleroma. 

7. Cancer is one of the most important diseases of the 
nose, especially from the standpoint of early differential 
diagnosis. An early diagnosis is made by the microscopic 
examination of a section of the diseased tissue. Such a sec- 
tion should extend from the healthy tissue into the patho- 
logical growth, and it should be removed with as little 
laceration and irritation as possible. The secretion is not 
so tenacious, stringy and adherent to the growth as in 
tubercular lesions. Carcinoma may be limited to the nose 
but is likely to invade adjacent structures. The growth 
is irregular and tends to ulceration. There is severe pain, 
the ulcers do not tend to heal, and the disease is not affected 
by the therapeutic test for syphilis. Syphilis shows lesions 
in remote parts of the body. The syphilitic lesions are 
usually fairly firm, with surrounding areas of inflammation. 
In syphilis there is a tendency to ulceration, but these tend 
to heal, are not especially painful except when irritated, and 
respond to the therapeutic test for syphilis. Fibroma is 
usually a painless growth, dense and firm, often pedunculated, 
that does not tend to ulceration and does not respond to anti- 
syphilitic treatment. 



Diagnosis of Syphilis. 137 

8. Simple chronic catarrh of the nose may be caused 
by an acute catarrh becoming subacute and later chronic. 
Thus the causes of acute catarrh of the nose, when long 
continued, may produce a chronic catarrh. Common causes 
are bad ventilation, dust, tobacco, and snuff. The symptoms 
are less intense than in acute catarrh of the nose and of 
longer duration. Diagnosis calls for differentiation from 
acute catarrh, polypus, and syphilis. Inspection reveals the 
mucous membrane swollen, especially over the turbinated bones, 
and covered more or less by secretion. There may be ulcers 
or erosions of the mucous membrane. Syphilitic catarrh of 
the nose is characterized by lesions involving the deeper struc- 
tures as well as the mucous membrane. In syphilis, there 
are frequently evidences of the disease elsewhere. Doubtful 
cases justify the therapeutic test. 

9. Intumescent rhinitis, a form of chronic catarh char- 
acterized by rapid swelling of the nasal mucous membrane, 
especially over the turbinates and the septum, is more liable 
to be mistaken for iodism than for syphilis. Intumescent 
rhinitis is not relieved by withdrawing iodin, and the attacks 
usually occur during the spring and fall. The swelling 
of the mucous membrane is due to an exudate, that may 
gravitate from one side to the other. The breath is often 
offensive, the tongue coated, and there may be gaseous eructa- 
tions and digestive disturbances. 

10. Hyperplastic rhinitis is characterized by hypertrophy 
of the turbinates with an increase of the connective tissue 
elements of the submucosa. The condition has been compared 
to hypertrophic cirrhosis of the liver. This is not to be 
confused with the hypertrophic stage of atrophic rhinitis, 
which corresponds to the hypertrophic stage of cirrhosis of 
the liver. Hyperplastic rhinitis differs from the simple exuda- 
tive rhinitis inasmuch as the hyperplastic tissue does not 
contract upon the application of cocaine or adrenalin, or at 
any rate there is not so great contraction as is observed in 
the simple exudative forms of rhinitis. Indentations, such as 
may be made with a probe, show a firmer tissue that more 



138 Diagnosis of Syphilis. 

slowly returns to the normal than in simple exudative rhinitis. 
Hyperplastic rhinitis does not present the appearance of 
any of the syphilitic lesions ; there is not so great deformity, 
nor the tendency to the destruction of tissue that is common 
in syphilis. 

11. Ozena is a much abused term. Early in the evolu- 
tion of nosology, ozena was regarded as a disease of the 
nose characterized by an offensive odor. At the present time 
ozena is more properly considered as a symptom, characterized 
by a nasal stench or fetid odor, that may be perceptible 
to the patient or to those about him, or to both ; that may 
be unilateral or bilateral, constant or intermittent, and that 
may or may not be influenced by the application of disin- 
fectants. Syphilis, especially through the destruction of 
bone, is one of the most prominent causes of ozena. Ozena 
may assume importance in atrophic rhinitis. The presence 
of dead bone from any cause, suppurative sinusitis, glanders, 
coryza caseosa, cancer, benign neoplasms, congenital mal- 
formations, and foreign bodies in the nose may cause ozena. 
Sometimes it is due to the extension of dental caries to the 
nose. The odor is readily recognized ; the chief problem 
is to find the cause. 

12. Atrophic rhinitis is marked by atrophy of the nasal 
mucous membrane ; tbe turbinates appear reduced in size, the 
interior of the nose is larger than normal, and there is usually 
ozena, due to decomposition of the secretions of the nose. 
This form of rhinitis should be differentiated especially from 
lupus, syphilis, frontal, ethmoidal and maxillary suppurative 
sinusitis, and from rhinoliths and foreign bodies in the nose. 
The ozena of syphilis differs in odor from that of atrophic 
rhinitis. Syphilitic ozena is due to the presence of dead bone ; 
the ozena of atrophic rhinitis, as stated, is due to the decom- 
position of the nasal secretions. Syphilis is marked by ulcera- 
tion and destructive changes, rather than by simple atrophy 
of the mucous membrane. Syphilis more frequently involves 
the septum ; atrophic rhinitis affects the turbinates. Doubtful 
cases justify the therapeutic test. 



Diagnosis of Syphilis. 139 

13. Frequently there is a purulent rhinitis in syphilis. 
But there are many other causes of purulent rhinitis. The 
condition may be due to trauma or the presence of foreign 
bodies in the nose. It may be regarded as a septic infection 
of the nose. The characteristic feature is the discharge from 
the nose of a thick, tenacious mucopurulent material, often 
of a yellow color. There may be some fever with the attack. 
The discharge is irritating, and often causes excoriation and 
even ulceration of the upper lip with which it comes into 
contact. There is little odor, which is increased if the dis- 
charge becomes more tenacious so that it remains in the nose 
and undergoes decomposition. There is little, if any obstruc- 
tion of the nose. 

14. Nasal hydrorrhoea would hardly be mistaken for either 
syphilis or iodism. The history is entirely different from 
either of these diseases. The constant and abundant discharge 
of clear fluid, occuring often in attacks that show more or 
less periodicity, is characteristic of hydrorrhoea. The affection 
is obstinate to treatment, and is not affected by the exhibition 
or withdrawal of the iodides or other anti-syphilitics. 

15. Chronic edematous rhinitis is marked by swelling of 
the turbinates, intermittent or constant, with consequent in- 
terference with nasal respiration. The swelling is due to a 
watery infiltration into the connective tissue. Any interference 
with the venous or arterial circulation may be a causative 
factor. Thus, affections of the liver, kidney, heart, and lungs 
may enter into the etiology of this condition. 

Nasal ulcer may be caused by chancre. This is rare. It 
has been described as granular in appearance, or hard and 
cartilaginous, with an ulcerating surface. There is epistaxis 
and occlusion of the nose. Involvement of the alas is followed 
by deformity. 

During the second stage, ulcer of the nose may be due 
to the mucous patch, or superficial ulcers may be formed by 
the breaking down of papular or pustular syphilides. The 
mucous patch may cause little or no discomfort, and presents 
the general appearance of that lesion on other mucous mem- 



140 Diagnosis op Syphilis. 

branes. The superficial ulcer is not so common. It is usually 
situated upon the septum, but may be found upon the floor 
of the nose or on the turbinates. It has well-defined borders, 
and the surrounding mucous membrane is apparently healthy. 
The surface of the ulcer may be somewhat depressed, of a 
grayish-pink color, covered with thick, stringy, yellowish gray 
mucopus. There is slight sensitiveness to touch. The lesion 
bleeds easily, but there is no tendency to extend. 

During the third stage of syphilis, a superficial ulcer may 
be due to the breaking down of a superficial gumma. But 
during this stage of the disease the more characteristic lesion 
is the deep ulcer with bony necrosis, due to the disintegration 
of deeper gummata. As is common with syphilitic ulcers, 
there is a preference for the septum, though other parts of 
the nose, especially the turbinates, are not exempt. These 
ulcers usually occur some ten or fifteen years after the primary 
infection, so that we will frequently find the history or evi- 
dence of other syphilitic lesions. 

Nasal Ulcer. 

Syphilitic nasal ulcer should be differentiated from : 

1. Catarrhal erosions. 11. Leprosy. 

2. Herpetic ulcerations. 12. Glanders. 

3. Eczema. 13. Diphtheria. 

4. Ulcer due to foreign bodies. 14. Measles. 

5. Neuroparalytic ulcers. 15. Rheumatism. 

6. Scurvy. 16. Scarlet fever. 

7. Diabetic ulcers. 17. Smallpox. 

8. Varicose ulcers. 18. Typhoid fever. 

9. Cancer. 19. Typhus. 
10. Tuberculosis. 

1. The simple non-syphilitic catarrhal ulcer usually occurs 
near the anterior nares, upon prominences, such as exostoses 
of the septum, or where the mucous membrane is thinned by 
pressure, as by enlarged turbinates that encroach upon the 



Diagnosis of Syphilis. 141 

septum, or in the presence of retained secretions. The ulcer 
is sensitive, and the nasal discharge is profuse. The diagnosis 
is aided by the painful character of the simple ulcer, the de- 
tection of the cause, and the absence of symptoms or evidence 
of syphilis. Simple catarrhal ulcers may occur in syphilitics ; 
in such cases the diagnosis is based chiefly upon the appear- 
ance of the lesion. The catarrhal ulcer is more sensitive and 
does not present the infiltration observed in syphilitic lesions. 
There may be epistaxis, but occlusion of the nose is not so 
prominent in these cases as in the ulcers due to syphilis. 

2. Herpes may be a cause of nasal ulcer. The course and 
appearance are so different from those presented by syphilitic 
ulcer, that mistakes in diagnosis are not likely to occur. The 
herpetic ulcer is due to the breaking down of herpetic vesicles. 
These may be confluent. There is a rise of temperature and 
pulse, and considerable local discomfort. 

3. Nasal ulcer may be caused by eczema. "Eczema" is a 
term that has been so much abused that we almost hesitate to 
use it. The disease may be acute, but is usually chronic. 
There may be irregularly scattered or closely aggregated 
papules, vesicles and pustules, or a diffuse redness and swell- 
ing, the surface scaly, covered with papules, vesicles and 
pustules, and weeping or covered with yellow, gummy crusts. 
The diagnosis is aided by finding the cause of the eczema, 
such as an irritating discharge from the eye. Often children 
will show eczema on the upper lips and cheeks. Irritation 
of the bowels, by ascarides or by improper diet, may be 
etiological factors. The nasal crusts are accompanied by irri- 
tation, that often causes the patient to pick the nose, and 
this increases the irritation and prolongs the disease. The 
nasal discharge may or may not be copious, and usually is 
without marked odor. Adults often seem to suffer from 
malaise, especially after eating, thus presenting the picture of 
gastric catarrh. Usually there is an excess of urates in the 
urine. These points, especially the discovery of a cause of the 
eczema, with the general appearance of the lesion and the 



142 Diagnosis of Syphilis. 

absence of symptoms or evidence of syphilis, suffice to make 
the diagnosis. 

4. Foreign bodies mby cause nasal ulcer. The diagnosis 
is made by the discovery of the foreign body, or the history 
of its presence. When the ulcer does not heal immediately 
upon the removal of the foreign body, it presents the appear- 
ance of a simple catarrhal ulcer. 

5. Neuroparalytic nasal ulcer may be due to paresis or 
paralysis of the fifth nerve. The ulcers vary in size, are dry 
and sluggish, and show little tendency to heal. Epistaxis and 
loss of smell have been reported in these cases. 

6. Nasal ulcer due to scurvy is rare ; more frequently 
there is a traumatic or catarrhal nasal ulcer in cases of scurvy. 
The diagnosis is based upon the presence of an epidemic, the 
character of the food, the presence of other symptoms of 
scurvy, and the improvement following the use of proper food. 
The nasal lesion leads to a fetid, offensive discharge. The 
ulcer is fungoid in appearance, bleeds easily, and the edges 
are hard, thick and shiny. The ulcer shows a tendency to 
extend. 

7. Diabetes may be accompanied by nasal ulceration, usu- 
ally near the anterior nares, due to picking the nose for the 
relief of the nasal irritation common in diabetes. The diag- 
nosis is made by the detection of glycosuria and the recogni- 
tion of other symptoms of diabetes. 

8. Venous stasis may lead to the formation of varicose 
ulcers, especially upon the turbinates, and sometimes on the 
posterior border of the soft palate. The ulcers are indolent, 
irregular in outline, shallow, and bleed easily. The mucous 
membrane is cyanotic, and a search may disclose the cause 
of the venous stasis. 

9. Cancer is one of the most important causes of nasal 
ulcer, and the differentiation between this condition and syph- 
ilitic ulcer ma}- be difficult. Should the appearance of the 
lesion and the concomitant symptoms and history not suffice 
to make the diagnosis, we are justified in removing a section 
for microscopic examination and also in making the therapeutic 



Diagnosis of Syphilis. 143 

test. We should not forget that cancer may develop in a 
syphilitic and even upon a syphilitic lesion. Furthermore, 
when the iodides are pushed they sometimes cause a temporary 
retrogression of cancerous growths. The cancerous ulcer does 
not tend to heal, and the pain is severe. In syphilis, the ulcer 
tends to heal, and usually there is little or no pain save upon 
irritation. 

10. Tubercular ulcers are rare in the nose. They occur 
especially upon the septum, sometimes upon the turbinates. 
The ulcer is grayish white in appearance, with an irregular, 
ill-defined outline. Sometimes miliary tubercules may be seen 
in the mucous membrane outside of the ulcer. The ulcers 
bleed easily. The therapeutic test is often a valuable diag- 
nostic aid. Usually there is pulmonary tuberculosis, and some- 
times there is general miliary tuberculosis. At any rate, cases 
presenting a tubercular ulcer respond to the tuberculin test. 

11. Uulcer of the nose is not uncommon in leprosy. The 
leprous ulcer is accompanied by a very offensive bloody, watery 
discharge. There may be great deformity, perforation of the 
septum and destruction of the- alae. Bleeding is often an 
early symptom. The diagnosis is usually easy because of 
other leprous lesions. The tertiary syphilitic ulcer presents a 
different history. Doubtful cases should be subjected to the 
therapeutic test. 

12. Nasal ulcer is rarely due to glanders. The diagnosis 
may be aided by a knowledge of the occupation of the pa- 
tient — possibility of contact with diseased animals or with 
patients having the disease. The course and history differ 
markedly from syphilis. The incubation is usually three or 
four days. The point of inoculation shows swelling and red- 
ness with inflammation of the lymphatics. Nodules form in 
the nasal mucous membrane and break down to form ulcers, 
from which there is a muco-purulent discharge. Papules, 
which soon become pustules, appear on the face and over 
joints. The patient experiences chilly sensations, fever head- 
ache, and prostration. Mallein, a product of the glanders 
bacillus, is used in the diagnosis of glanders, much as tuber- 



Hi Diagnosis of Syphilis. 

culin is used in the diagnosis of tuberculosis. Should mallein 
not be accessible, a male guinea pig may be inoculated, or 
better, several of them. The inoculation is made into the 
abdominal cavity. Two to five days after inoculation, the 
testicles and their sheaths become swollen and purulent. 
Glanders does not respond to the therapeutic test for syphilis, 
and this may be of value, especially in cases of chronic 
glanders that may cause nasal ulcers and often also laryngeal 
symptoms. 

13. Diphtheria may cause nasal ulcer either primarily or 
secondarily. The presence of an epidemic, and the history 
of exposure to infection and absence of previous attack, are 
valuable aids in some cases. A false membrane is usually 
present, but in the nose it may not be visible. The diagnosis 
rests chiefly upon the recognition of the bacillus diphtheria, 
in the presence of symptoms of systemic intoxication. Chronic 
croupous or fibrinous ulcer is sometimes apparently due to 
chronic nasal diphtheria. Such cases seem to depend largely 
upon lowered bodily resistance to the bacillus, due to defective 
nutrition. 

14. Nasal ulcer may be due to measles, but in such cases 
the question of differentiation from syphilis will seldom arise. 
Sometimes an eczematious nasal ulcer follows measles. 

15. Rheumatism may cause nasal ulcer. Such cases are 
probably due to the streptococcus. At any rate, a strepto- 
coccus of low virulence may be found in these cases. The 
ulcer responds readily to topical treatment and proper atten- 
tion to the rheumatism. 

16- Scarlet fever may cause nasal ulcer, which is usually 
due to hemorrhagic inflammation. Streptococci are usually 
present. The appearance, history and course suffice to make 
the diagnosis. 

17. Smallpox may cause ulcer and great nasal deformity. 
The concomitant symptoms will scarcely permit of confusion 
with syphilis. The prevalence of an epidemic, the history 
of a previous attack, inoculation or successful vaccination, are 
points that aid in diagnosis. The sudden onset of the disease 



Diagnosis of Syphilis. 145 

with chills or rigor, followed by fever, headache, pain in the 
back, epigastric tenderness, and vomiting, is suggestive. The 
appearance of the eruption on the third day, first upon the 
upper part of the face, extending rapidly over the body, 
changing from macules and papules to vesicles, which are 
umbilicated and later become pustules, stamps the disease. 
With the exanthem there appears an eruption upon the nasal 
mucous membrane, and upon all the mucous membranes that 
are exposed to the air (mouth and pharynx, sometimes in the 
vagina, rectum and urethra). The temperature falls with the 
appearance of the eruption. The nasal ulcer is accompanied 
by nasal swelling, pain, tenderness, and discharge. 

18. Nasal ulcer may occur in cases of typhoid fever, and 
may be due to the typhoid bacillus or to secondary infection, 
especially by streptococci. The ulceration is often severe, 
associated with chondritis or perichondritis. There may be 
affection of the turbinates. The involvement of the nasal 
cartilage and bone is followed by deformity. The history and 
course differ markedly from syphilis. 

19. Typhus fever may cause nasal ulcer. The acknowl- 
edge of the existence of the disease in the neighborhood is of 
value in diagnosis. Isolated cases are sometimes difficult to 
recognize, especially in the absence of an eruption. The sud- 
den onset, great prostration, with the dense cloud about the 
brain, and the peculiar eruption, appearing about the third 
day and sparing the face, and the crisis at the end of the 
second week, are characteristic. 

Accessory Sinuses. 

Affections of the accessory sinuses most frequently assume 
prominence during the third stage of the disease. Thus, a 
chronic purulent ethmoiditis or an empyema of the sphenoidal 
sinus may be due to syphilis. Disease of the ethmoid, during 
the third stage of syphilis, should be considered syphilitic 
unless proven otherwise. The iodide of potassium test is im- 



146 Diagnosis of Syphilis. 

portant. The ethmoidal turbinated bone is gummatous more 
frequently than the ethmoidal cells. When the ethmoidal cells 
are gummatous, the process usually attacks the bone and soon 
causes cerebral symptoms. The other accessory sinuses are 
less frequently affected by syphilis. Cases of doubt may be 
subjected to the therapeutic test. 



Syphilitic Snuffles. 

The syphilitic "snuffles" of hereditary syphilis usually, but 
not invariably, occur within a week of birth. This rhinitis 
resembles an ordinary cold. The discharge, at first watery, 
becomes muco-purulent, and causes irritation of the margin 
of the nostril and the upper lip. Later the diagnosis is con- 
firmed by the wizened, old-man appearance and the cachexia. 
The anus, less frequently the mouth, may show mucous patches. 
The therapeutic test should be considered in all doubtful cases. 



NASOPHARYNX. 

We have already referred to the oropharynx. The naso- 
pharynx is frequently involved in the second and third stages 
of syphilis. The primary lesion in this locality is rare. But 
infection may be conveyed by a contaminated hand or dirty 
instruments. 

Chancre of the nasopharynx causes nasal obstruction, 
which is more pronounced than in acute catarrh. The nasal 
voice is more marked and of longer duration. There is 
dysphagia, but the deglutition is not so painful as in some 
cases of acute catarrh. With these symptoms of obstruction 
there is swelling of the cervical lymphatic glands at the 
angle of the jaw and along the sterno-cleido-mastoid muscle. 
Usually the location of the enlarged glands, and whether they 
are swollen on one or both sides of the neck, seems to depend 
upon the location of the chancre, and whether it is located in 



Diagnosis of Syphilis. 147 

the middle of the nasopharynx or to one side. But some- 
times, probably through the anastomoses of the lymphatics, a 
chancre located upon one side of the nasopharynx may cause 
enlargement of the lymphatic glands upon the opposite side 
of the neck. Simple adenitis would not show the same rapid 
formation of indolent buboes, with distinct separation of the 
glands from one another. 

During the second stage of syphilis, syphilides occur in 
the nasopharynx, though they are apparently not so common 
as about the fauces. Mucous patches may occur in this region, 
especially upon Luschka's tonsil. It should be remembered 
that adenoids may be syphilitic. Such hypertrophies of the 
adenoid tissue respond to anti-syphilitic treatment. The swell- 
ing of the cervical lymphatic glands is less marked than during 
the first stage. 

The nasopharynx is most frequently affected during the 
third stage of syphilis. Gummata, with subsequent deposition 
of scar tissue, are the most frequent manifestations of the 
disease in this locality. Necrosis of bone is also common. 

Gumma of the nasopharynx is usually circumscribed, but 
may be diffuse. Depending upon its location, there will be 
the presence of a more or less well-marked tumor, obstruction 
to the nose, and frequently pains due to pressure. Thus there 
may be earache, pain in the back of the head, and dysphagia. 
Diffuse gumma may cause infiltration of the velum, with 
immobility of the pillars of the fauces. The mucous mem- 
brane is wine-red in color. 

The catarrhal form of tertiary syphilis of the naso-pharynx 
differs from a simple adenoiditis by the gangrenous appear- 
ance and the subsequent ulceration. 

Ulceration may be regarded as the rule in gumma of the 
nasopharynx, though occasionally cases occur in which the 
gumma undergoes sclerotic changes without ulceration. Fre- 
quently the ulceration is extensive, causing great deformity, 
at times opening up the large vessels of the neck, or involving 
the vertebras. Most frequently the ulceration attacks the 
velum. The Eustachian tubes may be affected. 



148 Diagnosis of Syphilis. 

It may be necessary to differentiate syphilis of the naso- 
pharynx from a number of other diseases, notably : 

1. Tuberculosis of the nasopharynx; Lupus. 

2. Cancer of the nasopharynx. 

3. Gangrenous ulceration. 

4. Simple tumors ; polyps. 

5. Glanders. 

6. Actinomycosis. 

7. Simple nasopharyngitis. 

8. Atropine nasopharyngitis. 

9. Hyperplastic nasopharyngitis. 

10. Affection of nasopharynx in infection. 

In obscure cases, if we do not know that the patient is a 
syphilitic, the diagnosis may be cleared up by searching for 
the spirochete pallida, or by making the Wassermann test. 
But we should not forget that syphilitic patients may present 
non-syphilitic affections. 

In tertiary necrosis of the sphenoid bone, Moure has noted 
severe lancinating pains referred to the fundus of the eye, 
diplopia, and often profuse suppuration. Such cases are not 
cured by specific syphilitic treatment until the sequestrum 
is removed. 

Cicatricial tissue may be deposited in various quantities. 
A nasal fossa may be occluded or the entire nasopharynx may 
be obliterated. The most frequent change is immobility of the 
velum. This causes a persistent marked nasal voice. 

The differential diagnosis of tertiary syphilis of the naso- 
pharynx may be rendered easy by the previous history of the 
case, the comparative indolence of the disease, and the absence 
of adenopathy. The ulcerations of tuberculosis are painful 
and occur late in the disease. Cancer of the nasopharynx 
is comparatively rare, shows indurated granulating borders 
that may be readily broken down and bleed easily. They 
show more marked dysphagia and cachexia. Gangrenous 
ulceration is a more acute affection, runs a more rapid course, 



Diagnosis of Syphilis. 149 

with marked pain and the characteristic odor of the breath. 
In both this affection and cancer, the isthmus of the fauces 
is more frequently involved than in tertiary syphilis of the 
nasopharynx. Syphilitic cicatricial tissue would rarely be 
mistaken for a malformation. The appearance and the his- 
tory of the case would practically exclude such a possibility. 
Lupus is of comparatively slow growth, and its ulcerations are 
usually more superficial than those of syphilis. Doubtful cases 
may be subjected to therapeutic tests with anti-syphilitics and 
tuberculin, and the microscopic examination of the affected 
tissue. 

LARYNX. 

All stages of syphilis may involve the larynx. Chancre 
of the larynx is extremely rare. Bosworth was able to find 
but one reported case. In that case the lesion occurred upon 
the left side of the epiglottis. 

The second stage of syphilis is represented in the larynx, 
especially by the erythema, the mucous patch, and the super- 
ficial ulcer. 

Erythema, laryngitis syphilitica erythematosa, commonly 
known as syphilitic catarrh, occurs usually from four to six 
months after the primary infection. It may be present as 
early as one month, or as late as two years or longer in 
appearing. The severity of the inflammation and the symp- 
toms vary greatly. The secretion may be little or great. 
There may be only an erythema and infiltration, possibly with 
erosions ; or the infiltration may extend so deep as to involve 
the muscles and cause paresis. In the presence of little secre- 
tion, there may be the formation of crusts, which may adhere 
to the vocal cords and agglutinate them. Furthermore, the 
erythema is usually general, involving the entire larynx; but 
it may be localized, limited to a part of the larynx, as the 
epiglottis, the aryepiglottic folds, the false vocal cords ; or 
the erythema may be general over the larynx, but more in- 
tense in certain parts. 



150 Diagnosis op Syphilis. 

The erythema produces changes in the voice, ranging from 
simple hoarseness to absolute aphonia. There is usually cough, 
the character of which depends largely upon the amount of 
secretion. 

In the presence of erythema, inspection of the larynx re- 
veals a change in color, which is a darker red than is observed 
in the simple acute forms of laryngitis. Often there is a 
mottled appearance that is almost characteristic. Venous 
turgescence is especially marked over circumscribed spots. 

The cases of extensive infiltration show more uniformly 
diffuse swelling than is found in simple inflammation of the 
mucous membrane or simple perichondritis. These character- 
istics, with the clinical history of the case, possibly with a 
resort to the therapeutic test, suffice to make the diagnosis of 
syphilitic erythema of the larynx. 

The mucous patch is much more rare than erythema of 
the larynx. The mucous patches may be single or multiple, 
and occur from six weeks to a year after the primary infec- 
tion. They are most frequently located on the upper 
surface of the vocal cords, less frequently upon the epiglottis, 
the arytenoids, and the ventricular bands. The lesion appears 
as a small, superficial, grayish patch, slightly raised, possibly 
surrounded by a red areola. 

The superficial ulcer may occur in the second or third 
stage of syphilis, developing from a mucous patch or result- 
ing from the breaking down of a superficial gumma. It 
occurs from two to seven years after primary infection. The 
chief characteristics are the chronicity, the slow destruction 
of tissue, and the comparatively few symptoms produced by 
the lesion. There may be some impairment of the voice, and 
the secretion may contain pus and blood. Relapses are fre- 
quent, constituting the relapsing ulcerative syphilitic laryn- 
gitis. Bosworth believes that the relapses are catarrhal exacer- 
bations rather than true relapses. Inspection of this lesion, 
which is not common, shows a roundish ulcer, but slightly 
excavated, covered with a bright yellow coating, possibly 
tinged with blood, and without a marked areola. The superfi- 



Diagnosis of Syphilis. 151 

cial ulcer is most frequently situated upon the vocal cords, 
where it is most difficult to recognize because of the slight 
lesion and comparative absence of membrane and areola. 
Furthermore, the lesion may occur in the presence of a tuber- 
culous process. 

The third stage of syphilis of the larynx is marked by 
gumma, with the formation of superficial or deep ulcers and 
subsequent cicatricial stenosis. These lesions do not occur 
until late, usually five or ten years or longer after infection. 
They constitute by far the most frequent serious syphilitic 
affections of the larynx. The gummata develop especially in 
the deeper tissues, the mucosa and periosteum, and vary in size 
from microscopic nodules to masses as large as a cherry, or 
larger, that may completely occlude the larynx. The gum- 
mata usually appear rather suddenly. I saw a case, in which 
the gumma almost entirely closed the larynx, that the patient 
declared developed within an hour's time. The tumors are 
smooth, rounded, and may be single or multiple. The over- 
lying mucous membrane may remain comparatively healthy in 
appearance, or the whole mass may break down, to constitute a 
superficial or deep ulcer, depending upon the depth at which 
the gumma develops. The history of other symptoms of 
syphilis may aid in diagnosis. Differential diagnosis calls 
especially for the exclusion of tuberculosis and cancer. In 
all doubtful cases the therapeutic test should be applied. 

The superficial ulcer has already received consideration 
under the second stage of syphilis of the larynx. 

The deep syphilitic ulcer of the larynx is one of the 
most important lesions with which we have to deal. The deep 
ulcer appears usually from five to ten years after infection, 
and results from a breaking down of a gumma. A gumma 
of the larynx usually breaks down within a short time, although 
they may remain unulcerated for as long as two years. Upon 
ulceration, the secretion contains pus and necrotic tissue. 
Usually there is no marked hemorrhage. The lesion involves 
most frequently the epiglottis, vocal cords, ventricular bands, 
and the arytenoid commissure. 



152 Diagnosis of Syphilis. 

Involvement of the superficial tissues — the soft parts of 
the larynx — is marked by edema and vascular tumefaction ; 
affection of the deeper parts results in perichondritis and 
necrosis. In general, simple ulceration occurs in the earlier 
years of syphilis of the larynx ; and perichondritis and necrosis 
occur later, usually after there is more or less cicatricial 
stenosis. 

Inspection of a deep ulcer reveals a deep, excavated ulcer 
with sharp edges, profuse secretion, and dark red areola. The 
tuberculous lesion does not show the areola, but rather a 
grayish ulcer, usually not markedly excavated, with com- 
paratively little tenacious secretion, and the surrounding 
mucous membrane is comparatively pale. Lupus is irregular 
in outline, usually without ulceration, as a rule with only a 
slight injection of the mucous membrane. Sarcoma shows the 
presence of a tumor, with or without ulceration, but usually 
without the distinct ulceration and pus secretion observed in 
the deep ulcer of syphilis. Carcinoma causes a tumor that 
usually is more nodular and not so regular in outline as the 
gumma, and the carcinomatous ulcer is more irregular and 
does not show the sharp edges nor the areola of the syphilitic 
ulcer. In carcinoma there is marked tendency to hemorrhage 
after ulceration has begun ; the cervical lymphatics are in- 
volved and cachexia rapidly develops. 

Gumma of the larynx may be either circumscribed or 
diffuse. The diffuse form, especially, resembles at times 
scleroma of the larynx, which is comparatively rare and may 
be recognized by finding the rhinoscleroma bacillus. 

It is well to bear in mind that the spirochete pallida and 
the Wassermann reaction may be found in all stages of 
syphilis. 

Cicatricial stenosis of the larynx occurs late in the third 
stage of syphilis, most frequently, and might be classed among 
the lesions of the fourth stage of the disease, along with 
amyloid changes in various parts of the body. The diagnosis 
of the syphilitic origin of scars in the larynx is usually easy, 
because of the presence of the symptoms or evidences of other 



Diagnosis op Syphilis. 153 

manifestations of the disease. But at times the diagnosis of 
the specific origin of the cicatricial tissue may be extremely 
difficult. The syphilitic scars, especially the cicatricial dis- 
tortions following deep ulceration, cause marked deformity of 
the larynx. There , is not the same great deposition of scar 
tissue in cancer or tuberculosis. One form of tuberculosis, 
lupus, may cause some deformity through cicatrization. But 
the process is not so marked in lupus as in syphilis. 
There are cases of syphilis in which there is compara- 
tively little destructive change, and in such cases the clinical 
history may be of value in the differentiation from the 
cicatrization of lupus. 



LARYNGITIS. 

Finding the spirochete pallida and the Wassermann reac- 
tion will often clear up obscure cases. But syphilitics enjoy 
no immunity against non-syphilitic affections. 

At first the patient with syphilitic laryngitis often be- 
lieves that he has an ordinary "cold." This is the diagnosis 
that he often brings us, and it only serves to emphasize the 
danger of accepting the diagnosis made by the patient, 
before we have arrived at an opinion through a careful exam- 
ination of the case. The syphilitic erythema appears in the 
larynx usually within six months after the primary lesion, 
as a rule just after the subsidence of the skin eruption. 
Laryngoscopy reveals an erythema, uniform or mottled, in- 
volving part or all of the posterior surface of the epiglottis, 
the aryepiglottic folds, the false cords, and possibly the true 
vocal cords, which are sometimes infiltrated and swollen. The 
patient complains of few symptoms. There is no pain, deglu- 
tition is not interfered with, and usually the cough is not 
troublesome. There may be hoarseness or aphonia. If we 
but suspect the disease, the diagnosis may be readily made by 
the therapeutic test. 

Ulcers may be recognized by inspection. The superficial 



154 Diagnosis op Syphilis. 

syphilitic ulcer often shows a tendency to extend, new ulcers 
forming as the old ones heal. These are the so-called cases 
of recurrent ulcerative laryngitis. It often requires careful 
inspection to recognize ulcers on the vocal cords, when they 
involve only the thin mucous membrane in this region. 

Mucous patches are comparativeely rare in the larynx, and 
are usually associated with a similar involvement of the tongue 
or pharynx. They occur most frequently upon the upper sur- 
face and the free margins of the epiglottis, the aryepiglottic 
folds and the vocal cords. 

Condylomata are rare, and may be recognized as small, 
yellowish pimples, with an elevated base. 

Syphilitic laryngitis should be differentiated from: 

1. Simple acute laryngitis. 

2. Laryngitis of the infections. 

3. Rheumatic laryngitis. 

4. Simple acute epiglotitis. 

5. Traumatic laryngitis. 

6. Suppurative laryngitis. 

7. Edema of the larynx. 

8. Membranous laryngitis. 

9. Hemorrhagic laryngitis. 

10. Simple chronic laryngitis. 

11. Follicular laryngitis. 

12. Atrophic laryngitis. 

13. Hyperplastic laryngitis. 

14. Simple hyperemia of the larynx. 

15. Pemphigus of the larynx. 

16. Tuberculosis. 

17. Chondritis and perichondritis. 

1. The objective and subjective symptoms of acute laryn- 
gitis are usually amply sufficient to enable us to make a 
diagnosis. There is an absence of the cutaneous eruption 
and the other symptoms of syphilis observed in cases of 
syphilitic laryngitis. Cough is more often troublesome in these 
cases, and usually assumes greater prominence than in syph- 



Diagnosis of Syphilis. 155 

ilitic erythema. There is more or less hoarseness and dyspnoea. 
The diagnosis is often aided by a knowledge of the cause. 
Among the etiological factors may be mentioned confinement 
indoors, especially in a vitiated atmosphere; exposure to cold 
and damp ; mouth breathing, excessive use of the voice, abuse 
of tobacco, alcoholic beverages and hot drinks ; irritating 
fumes or vapors and dusty air. Often the syphilitic patient 
is peculiarly susceptible to simple laryngitis on every expo- 
sure. However, such a susceptibility is more common in 
tuberculosis and rheumatism. 

2. An acute catarrhal laryngitis is not uncommon in a 
number of the infections, notably erysipelas, measles, scarlet 
fever, smallpox, typhoid fever, typhus, influenza, malaria and 
rheumatism. Erysipelas of the larynx may be primary or 
due to extension from the fauces or the nose. In such cases 
the diagnosis is sometimes cleared up by the extension of 
the disease to the face. Examination of the pus will reveal 
the streptococcus. There may or may not be symptoms of 
syphilis or the evidence or history of that disease. Erysipelas 
may occur in syphilitics. Laryngitis in measles is a part of 
the inflammatory affection of the upper respiratory tract, and 
is not likely to be confused with the laryngitis of syphilis. 
The symptoms resemble more those of iodism. There may be a 
hyperemia or slight catarrhal laryngitis in scarlet fever. 
There may be, especially in severe and grave cases, a laryn- 
gitis with edema, ulceration, or the formation of a pseudo- 
membrane, and rarely gangrene. The mild cases are most 
difficult to recognize. 

(a) Smallpox may cause a catarrhal laryngitis, or more 
severe involvement of the larynx, marked by edema, paralysis, 
swelling, destructive lesions, the formation of pseudomembrane, 
and possibly subsequent cicatricial contraction. The diag- 
nosis is usually readily made by the presence of other symp- 
toms of smallpox, the prevalence of an epidemic, the history 
of a previous attack, inoculation, or vaccination, and the char- 
acteristic skin eruption beginning on the third day, first upon 
the upper part of the face and extending rapidly over the 



156 Diagnosis of Syphilis. 

body, changing from macules and papules to vesicles, which 
are umbilicated and later become pustules. 

(b) Typhoid fever is sometimes accompanied by an acute 
laryngitis. There may be ulceration, that sometimes extends 
to cause chondritis and perichondritis. Edema may occur, as 
an alarming symptom. In typhus there is sometimes laryn- 
gitis, and in these cases ulceration is peculiarly destructive, 
involving the cartilages and greatly increasing the gravity 
of the prognosis. Concomitant symptoms usually make the 
diagnosis. 

(c) Influenza and hay fever are prominent causes of 
laryngitis. The symptoms resemble iodism more than syphilis. 
The diagnosis of influenza may be readily made absolute by 
finding the influenza bacillus. The periodicity of hay fever 
attacks is a striking characteristic. Both these diseases, of 
course, may occur in syphilitics as well as in non-syphilitics. 

(d) Malarial laryngitis seems especially prone to involve 
the epiglottis and cause edema. In suspected cases, the diag- 
nosis may be settled by an examination of the blood and 
the exhibition of quinin. 

3. Rheumatism may cause laryngitis, which is often 
marked by involvement of the laryngeal articulations. The 
vocal cords may be immobile, the articulations swollen and 
tender. There are often evidences of rheumatic affections of 
other parts of the body. Usually there is an accompanying 
tonsillitis. There is more or less lassitude and the patient feels 
below par. The patient may observe more or less roughness 
of the laryngeal articulations, and there may be distinct de- 
posits in these articulations, especially in the crico-arytenoid 
joints. There may be stiffness and aching of the muscles of 
the neck. 

4. Reference has been made to cases of laryngitis in 
which the inflammation was largely confined to the epiglottis. 
Epiglottitis often seems to be a part of an inflammation of 
the lingual tonsil. Such cases may present no laryngeal 
symptoms, save possibly laryngeal spasm upon attempting 
to swallow. The diagnosis is made by inspection. 



Diagnosis of Syphilis. 157 

5. Traumatic laryngitis is usually diagnosticated through 
a knowledge of the traumatism. There is usually more or less 
involvement of adjacent structures. The most common causes 
are burns, scalds, wounds, and foreign bodies. 

6. Suppurative laryngitis is usually readily recognized by 
the history of the case, the septic symptoms, the localized 
point of tenderness, and the course of the affection. The 
spot of tenderness may be recognized externally, and there 
may be some external swelling. Possibly the most common 
cause is syphilis, the recognition of which would depend upon 
the presence of additional symptoms of that disease. Many 
cases are due to typhoid fever, most frequently following the 
disease. 

7. Edema of the larynx may be due to many causes. The 
more important are trauma, fractures of the larynx, and 
injuries through the inhalation of irritating steam, fumes or 
vapors, or through laryngeal application of irritating sub- 
stances, or the entrance of such substances into the larynx 
during deglutition ; adjacent inflammations, such as ton- 
sillar or peritonsillar abscess, inflamed lymphatic glands, wounds 
or foreign bodies at the base of the tongue, in the pharynx 
or involving the lingual tonsil ; neighboring tumors, causing 
pressure or interfering with the venous circulation ; foreign 
bodies in the esophagus at the level of the larynx; chondritis 
or perichondritis ; the infections, especially typhoid fever ; and, 
possibly above all, in circulatory disturbances caused by dis- 
eases of the heart, kidneys, or liver. Diphtheria, scarlet fever, 
and localized septic infection are prominent causes. Acute 
edema is often accompanied by acute inflammation. Chronic 
edema of the larynx may occur in the absence of local in- 
flammation, and is usually due to retardation of the venous 
circulation through disease of the heart, kidneys, or liver. 
The diagnosis is easily made by inspection. Most important 
is the recognition of the cause. Syphilis is not a prominent 
cause of edema of the larynx, but may cause the condition 
through involvement of the larynx, or by interfering with 
the laryngeal venous circulation (gummatous infiltration, cica- 



158 Diagnosis of Syphilis. 

tricial contraction, or affection of the blood vessels), or by 
impairment of the circulation through affection of the heart, 
kidneys or liver. 

Chronic edema of the larynx is usually due to syphilis, 
tuberculosis, cancer, or chronic diseases of the heart, kidneys, 
or liver. The syphilitic causes are recognized by excluding 
the other possible causes and the recognition of the evidence 
or history of other signs and symptoms of syphilis. 

8. Membranous laryngitis is usually diphtheria, which is 
recognized by the demonstration of the bacillus. Any ulcer 
of the larynx may become covered by a membrane, that may 
be due to the bacillus diphtheria or the streptococcus or 
other organisms. Septic membranous laryngitis may occur 
in scarlet fever, measles, or in simple traumatic ulcer of 
the larynx. 

9. We will refer to laryngeal hemorrhage at this time 
in order to emphasize the distinction between this condition 
and hemorrhagic laryngitis. When practicable, laryngoscopic 
examination will usually suffice to determine whether or not 
the hemorrhage is from the larynx. Having determined that 
we are dealing with a laryngeal hemorrhage, we must next 
try to find the cause. Among the more prominent causes of 
laryngeal hemorrhage are syphilis, tuberculosis, cancer, trauma 
and the presence of foreign bodies. These causes act through 
causing ulceration or the wounding of a blood vessel. Some- 
times the hemorrhage is due to a sudden acute inflammation 
or a sudden distension of the blood vessel. Thus, among the 
etiological factors are those conditions that cause an increased 
blood pressure, such as interstitial hepatitis, Bright's disease, 
valvular disease of the heart, fibroid lung, and violent exer- 
cise or strain. 

True hemorrhagic laryngitis is due to rhexis of a vessel 
or vessels leading to hemorrhagic infarction. The laryngitis 
is secondary to the hemorrhage. If the extravasation is suffi- 
cient to interfere with breathing, it is considered a hema- 
toma rather than a simple infarction. If the hemorrhage 
finds exit to the surface, the expectoration will be tinged with 



Diagnosis op Syphilis. 159 

blood. If not discharged in this way, the infarct may be 
recognized upon laryngoscopic examination. Syphilis may 
play an important role in the etiology of hemorrhagic laryng- 
itis, through affection of the blood vessels. The symptoms are 
comparatively slight, as a rule. There may be some cough, 
and more or less alteration of the voice, depending largely 
upon the site and extent of the extravasation. In a case of 
bleeding from the larynx, inspection will exclude hemorrhage 
from the naso-pharynx, pharynx, tonsils (pharyngeal, faucial, 
and lingual), and possibly we may be able to recognize the 
source of the hemorrhage in the larynx. When blood issues 
from the larynx, and bleeding may not be detected above the 
vocal cords, and there are no pulmonary rales, the hemorrhage 
is probably from the larynx below the cords, or from the 
trachea. 

10. Simple chronic laryngitis may be differentiated from 
syphilitic laryngitis by the history and the therapeutic test in 
early cases. Syphilis is more prone to cause destructive lesions 
and subsequent scar formation with deformity of the larynx. 

11. Follicular or granular laryngitis is found especially 
in individuals who use the voice excessively. There is usually 
a similar inflammation of the pharynx in these cases. The 
condition is readily recognized upon laryngoscopic exam- 
ination. 

12. Atrophic laryngitis may cause nocturnal cough, espe- 
cially during the stage of mucus accumulation and crust 
formation. This is not observed during the stage of dimin- 
ished secretion, which is marked by an aggravating dry cough. 
The diagnosis is readily made by laryngoscopy. Crusts should 
not be mistaken for ulcerations. 

13. Hyperplastic laryngitis is marked by hypertrophy of 
the laryngeal tissue, with consequent symptoms of obstruc- 
tion and interference with the mobility of the larynx. The 
therapeutic test would exclude syphilis. 

14. Hyperemia of the larynx may be due to many of the 
causes of laryngitis, when they are not sufficient to cause an 
actual inflammation. The condition is found especially in 



160 Diagnosis of Syphilis. 

plethoric patients, those who use the voice excessively, or who 
use tobacco or alcohol habitually. 

15. Laryngeal pemphigus is usually accompanied by a 
similar affection of the pharynx and fauces. The herpetic 
eruption is accompanied by a rise of temperature and general 
symptoms. The throat is sore, the voice altered, there is 
dysphagia, and the eruption is recognized upon inspection. 
The vesicles rupture in a few hours, to leave superficial ulcers. 
The eruption may occur anywhere in the larynx, but is most 
frequent upon the ventricular bands and the arytenoids. 

16. Tuberculosis of the larynx is characterized by ulcera- 
tion rather than by inflammation, and will be considered later. 
However, in pulmonary tuberculosis there is often greater 
susceptibility to laryngitis. Syphilis and rheumatism show a 
similar predisposition. 

17. Chondritis and perichondritis may be due to syphilis, 
tuberculosis, actinomycosis, glanders, typhoid fever, smallpox, 
diphtheria, cancer, benign tumors, traumatism, embolism, rheu- 
matism, and the presence of foreign bodies. It has also been 
ascribed to decubitus in the aged. Exposure to cold and damp, 
and excessive use of the voice are also causes. 

Syphilitic chondritis and perichondritis may be recognized 
by the historj', and the evidence of syphilis in other parts of 
the body. Syphilis presents more external swelling, and also 
more tendency to heal than is observed in tuberculosis. Tuber- 
culous chondritis and perichondritis are rare in the absence 
of pulmonary tuberculosis. The worm-eaten appearance of 
the tuberculous ulcerations is more marked than in syphilis. 
The exposure to tuberculous patients, the possibility of infec- 
tion by tubercle bacilli, may be of diagnostic importance. The 
finding of tubercle bacilli in the sputum would speak for tuber- 
culosis in the respiratory tract. Such bacilli are usually from 
the lungs. There is not much discharge of tubercle bacilli 
from the laryngeal tissue. When due to typhoid fever, chon- 
dritis and perichondritis usually follows that disease or occur 
late in the course of the disease, so that the history materially 
aids the diagnosis. In cases of chondritis or perichondritis 



Diagnosis of Syphilis. 



161 



due to rheumatism or gout, there are usually evidences of these 
diseases in other parts of the body, and often the examination 
of the urine will aid in diagnosis. Traumatism and exposure 
to cold are readily recognized by the history. 



LARYNGEAL ULCERS. 



Gummatous Ulceb. 

1. Acute development 
of ulcer, within a few 
days. 

2. Swelling: marked, 
irregular, inflammatory 
or edematous. 



3. In affections of 
the epiglottis, a prefer- 
ence is shown for the 
upper surface. 

4. The syphilitic ul- 
cer is usually single, 
sometimes double, rare- 
ly more than this in 
number. 

5. Ulceration extends 
from center to periph- 
ery, and from above 
downward. 

<5. Ulcer is deep, 
round or oval in shape, 
and usually reaches a 
diameter of l.O-l.o cm. 

7. Cachexia may be 
observed late in the 
course of the disease. 

8. Frequently there is 
the history or evidence 
of syphilis. It should 
be remembered that any 
or all these diseases 
may co-exist. 

9. A n t i - syphilitic 
treatment specific. 



10. Spirochete pallida 
and Wassermann test 
reveal syphilis. 



Tuberculous Ulceb. Cabcinomatous Ulceb. 



1. Slow development, 
after throat symptoms 
for several months. 

2. Swelling: uniform, 
pale ; resembles an infil- 
tration. 



3. Lower surface of 
epiglottis most fre- 
quently affected. 



1. The ulcer develops 
in the course of a few 
weeks. 

2. Nodules situated 
in the midst of an 
acute catarrhal inflam- 
mation of the mucous 
membrane. 

3. May involve any 
part of the epiglottis. 



4. Usually multiple. 4. Usually single 



5. Ulceration usually 5. Ulceration is ir- 
extends upward. regular in its course. 



6. Ulcer is usually 6. Ulcer is irregular 
round, 2.0-3.0 mm. in in shape, usually 2.0-3.0 
diameter. mm. in diameter. 

7. Habitus phthisieus 7. Cachexia assumes 
and advanced cases may prominence early in the 



show cachexia. 

S. Practically all 
cases present pulmo- 
nary tuberculosis. 



disease. 

8. Frequently family 
history of cancer, or 
the history of associa- 
tion with cancer cases. 



9. A n t i - syphilitic 9. A n t i - syphilitic 
treatment of no value, treatment not specific. 
Most may be accom- 
plished by tuberculin 
and operative treat- 
ment. 

10. Tubercle bacilli 10. The histological 
ind tuberculin test show examination of tissue 
the presence of tuber- makes the diagnosis ab- 



culosis. 



solute. 



162 Diagnosis op Syphilis. 

Syphilitic laryngeal ulcers are usually unilateral, except 
when they involve the epiglottis, where they are usually central 
and most often on the upper surface. The ulcers develop 
rapidly and are accompanied by irregular inflammatory swell- 
ing and edema. The uleers are usually single, ovoid in shape, 
rather deep, and usually not more than one-half to one inch 
in diameter. 

Tubercular laryngeal ulcers present the history and symp- 
toms of tuberculosis, rather than of syphilis. The ulcers 
develop slowly, and are preceded by a uniform swelling of the 
mucosa resembling an infiltration. The ulcers are rather pale, 
compared with the syphilitic ulcers. The preceding swelling 
of the mucosa is accompanied b}' laryngeal irritation, so that 
there is the history of such irritation for some time before 
the ulcer appears. Tubercular ulcers in the larynx are usually 
bilateral. The ulcers are small, compared with the syphilitic 
ulcers, being usually less than 3 mm. in diameter, save when 
they coalesce, when they may reach 4 mm. in diameter. The 
ulcers are round, rather than ovoid. When syphilis and tuber- 
culosis co-exist, small individual ulcers in the larynx may at 
times be confusing. 

Lai^-ngeal ulcer due to cancer usually develops more rap- 
idly than tubercular ulcer and slower than the syphilitic ulcer, 
requiring a few weeks. The ulcer is preceded by tumefaction, 
and nodules extend beyond the area of ulceration. There is 
generally considerable inflammation of the surrounding mu- 
cosa. The ulcers are 2 to 3 cm. in diameter, solitary and 
irregular in shape. 

Sarcoma of the larynx causes tumefaction, and possibly 
there may be some denudation of the surface, but there is no 
distinct ulcer formation. 



Diagnosis op Syphilis. 



163 



LARYNGEAL GROWTHS. 



Syphiloma of the larynx usually does not come under ob- 
servation before ulceration. The pain is usually slight, very 
different from the constant lancinating pain of carcinoma or 
the severe dysphagia of tuberculosis. Around the ulcer there 
is some induration. There is little or no edema. The ulcer 
is clear cut and deep, often involving the cartilage. The 
surrounding mucous membrane is hyperemic and injected. 
Stenosis is not common, but may be caused by the subsequent 
contraction of scar tissue. Usually there are the evidences 
and history of syphilitic lesions in other parts of the body, 
and doubtful cases respond readily to the therapeutic test. 
Indeed, the ready response to the iodides makes it seldom 
necessary to resort to the removal of a section for microscopic 
examination in order to differentiate syphiloma from other 
tumors or masses in the larynx. 

In a tumor of the larynx of doubtful nature, if the 
sputum does not contain tubercle bacilli and the patient does 
not react to the tuberculin test; if we can not find the 
spirochete pallida, and the Wassermann reaction is negative, 
and especially if the tumor is growing and does not respond 
to the therapeutic test for syphilis, we are justified in making 
section of the growth for microscopic examination. For this 
purpose, it is usually better to remove the tumor, since the 
benign tumors of the larynx are peculiarly liable to become 
cancerous. The section is then made through the epithelium 
and fibrous tissue, since the microscopic diagnosis depends 
largely upon whether or not there is an invasion of the fibrous 
tissue by epithelial cells. 

At times it is necessary to differentiate between syphilomata 
and malignant or benign growths in the larynx, notably: 

1. Carcinoma. 6. Chondroma. 

2. Sarcoma. 7. Angioma. 

3. Papilloma. 8. Lipoma. 

4. Adenoma. 9. Mucocele. 

5. Fibroma. 10. Tuberculosis. 



164 Diagnosis of Syphilis. 

1. Carcinoma at first presents the signs of a simple growth 
in the larynx, depending largely upon the location and size 
of the neoplasm. Adenopathy is observed earlier in extrinsic 
than in intrinsic growths. Ulceration occurs comparatively 
early, usually within the first six months. With ulceration, 
hemorrhage assumes prominence. We have already referred 
to the cancerous ulcer. The breath becomes exceedingly of- 
fensive. Pain begins early, especially in extrinsic cancer, and 
is a prominent symptom. Later there is cachexia, which 
comes on earlier than in other laryngeal growths, and is more 
marked in extrinsic cancer. 

Carcinoma of the larynx affects men more often than 
women, and occurs most frequently after fifty. The voice 
shows early impairment. There is dyspnoea. Cough is caused 
by the mucous or seromucous discharge. The breath is 
offensive (the odor has been described as musty), and there 
is more or less hemorrhage. As a rule there is pain, and 
sometimes there is difficult deglutition. Cachexia comes on 
late or may be absent. Inspection reveals the hyperemic 
mucous membrane of the larynx. A new growth will be 
found within the laryngeal cavity, growing from any part 
of the larynx. Ulceration is slower than in syphilis, and 
extends in all directions and involves all tissues in its course. 
Stenosis is common. The therapeutic test for syphilis is 
negative; sometimes there is a slight response to excessive 
use of the iodides. There is late involvement of the cervical 
glands. 

2. Sarcoma at first resembles symptomatically a bengin 
tumor, the dysphagia, dyspnoea, and interference with the 
voice depending at first upon the location and size of the 
tumor. At first there is little cough, of an irritating, 
spasmodic, hacking character; after ulceration the cough in- 
creases. In sarcoma of the larynx, there is usually early 
ulceration, followed by more or less continuous hemorrhage. 
A sarcoma beginning in the larynx is not so prone to involve 
adjacent tissue; when beginning in the adjacent tissue there 
is a tendency to involve the larynx. The pain is usually 



Diagnosis op Syphilis. 165 

more marked than in syphilis, but not so continuous and 
prominent as in carcinoma. Cachexia occurs as the result 
of deficient nutrition, due to the interference with respiration 
and the dysphagia. 

Sarcoma occurs in the larynx very rarely. The majority 
of the reported cases have occurred in men. The ages of 
the patients have ranged from nineteen to seventy-four years, 
most of the cases occurring between forty and sixty. The 
symptoms are not especially characteristic. At first the 
voice becomes hoarse, sometimes aphonic. There are dyspnoea, 
cough, sometimes dysphagia. There may be slight hemorrhage 
and some pain. Late in the course of the disease there may 
be some cachexia. Involvement of the cervical lymphatics 
is usually absent. A positive diagnosis may be made by 
microscopic examination. 

Scleroma of the larynx is rare, and is associated with 
scleroma of the pharynx and nose. Finding the rhinoscleroma 
bacillus makes the diagnosis. 

3. Papillomata may occur in any part of the larynx, 
frequently in the anterior portion of the vocal cords. Usually 
interference with phonation is a prominent early symptom. 
There may be dyspnoea, due to the location and size of the 
growth. Hemorrhage is comparatively rare, and there is 
little or no pain. 

4. Benign adenoma of the larynx is comparatively rare. 
It must be remembered that adenomata and papillomata and 
all of the benign growths in the larynx, including syphilomata, 
are peculiarly prone to become cancerous, possibly because 
of the irritation and friction to which they are subjected. 

5. Laryngeal fibromata show a preference for the vocal 
cords. The cases usually come under observation while the 
growth is small, because of the interference with phonation. 
There is cough, and little or no pain. Ulceration and 
hemorrhage may occur but are not common in benign fibro- 
mata. From a diagnostic standpoint, it may be well to 
remember that papillomata and fibromata are the most common 
tumors of the larynx, and that they show a preference for 



166 Diagnosis of Syphilis. 

early life. Fibroma occurs usually as a sesile growth with 
a smooth vascular surface; papilloma is usually more promi- 
nent and the surface more irregular. 

6. Chondromata usually involve the cricoid cartilage, 
less frequently the thyroid, epiglottic and arytenoid cartilages. 
They present a hard, dense, lobulated tumor, of slow growth. 
Usually we may not find the cause. The tumors usually occur 
early in life, are of slow growth, and are not accompanied 
by inflammation, save such as may be caused by obstruction. 
Edema is absent or comes on late. The growth remains 
localized, without adenopathy or tendency to spread. 

7. Angioma is rare in the larynx. Such growths have 
occurred in the ventricular bands, and the epiglottis, usually 
as small bright red tumors. 

8. Lipoma is exceedingly rare in the larynx. The re- 
ported cases have usually occurred within the laryngeal cavity, 
and have not presented any marked difference from the 
appearance of lipomata in other parts. The epithelial cover- 
ing may be thickened. When incompletely removed, there 
is a tendency to recurrence. 

9. Myxomata, fibromyxomata and myxofibromata cause 
laryngeal irritation similar to that produced by a foreign 
body. Alteration of the voice and possibly interference with 
phonation will be caused, depending largely upon the location 
of the growth. The larger growths may cause actual dyspnoea. 
Pain and hemorrhage are comparatively rare. 

10. Tuberculosis is one of the most important affec- 
tions of the larynx, from the standpoint of differential diag- 
nosis. Tuberculosis of the larynx is rare in the absence 
of pulmonary tuberculosis. The sputum usually contains 
tubercle bacilli. Tuberculosis in the larynx or in any part 
of the body will cause a reaction to the tuberculin test. 
Therefore, in a doubtful case, we should hesitate to make 
a diagnosis of tuberculosis of the larynx if there are no 
tubercle bacilli in the sputum, and if the patient does not 
react to the tuberculin test. Tuberculosis may co-exist with 
either syphilis or carcinoma, or with both of these diseases. 



Diagnosis op Syphilis. 



167 



The patient with laryngeal tuberculosis suffers severe pain 
on deglutition as soon as ulceration occurs. At first the 
voice becomes altered, weak, sometimes aphonic. The use 
of the voice requires great effort. There may be an in- 
voluntary change from a low tone to a falsetto note, which 
may be maintained for a short time (Moure). The emacia- 
tion caused by the pulmonary tuberculosis, which usually 
precedes the affection of the larynx, is increased, and the 
expression of the patient becomes anxious. With extension 
of the disease, deglutition becomes difficult and painful. De- 
struction of the epiglottis may permit food to enter the 
larynx. Laryngoscopic examination reveals a pale mucous 
membrane. Small spots of induration may be observed, espe- 
cially in the interarytenoid space and at the base of the 
arytenoid cartilages. These are soon followed by marked 
edema, involving the arytenoids. The ulceration is compara- 
tively slow, and is broad rather than deep. Laryngeal stenosis 
is comparatively rare. There is no response to the iodides, 
unless there is a co-incident infection with syphilis. 

Lupus is due to the tubercle bacillus and may be regarded 
as a form of chronic tuberculosis. In the larynx it causes 
little or no pain. At first it appears as nodular masses, which 
may appear in any part of the larynx. There is little 
or no edema, and ulceration is slow or entirely absent. 
When an ulcer does occur, there is little or no discharge, 
in this respect differing from the common tubercular ulcer, 
which is usually covered with a thick mucopurulent secretion. 
In lupus, the surrounding mucous membrane is injected. 
There is little impairment of the general health. In these 
cases lupus of the skin is probably more frequent than pul- 
monary tuberculosis. However, a careful examination of 
the lungs will reveal chronic pulmonary tuberculosis, usually 
localized in one or both apices, more often than the literature 
would seem to indicate. Lupus does not respond to the 
therapeutic test for syphilis. 



168 Diagnosis op Syphilis. 

Stenosis of the Larynx. 

Syphilis may occlude the larynx in a number of ways. 
Occlusion due to edema may occur at any time in the course 
of the disease. The commonest form of syphilitic cicatricial 
stenosis is due to cicatricial tissue uniting the vocal cords 
or the ventricular bands, less frequently involving other parts 
of the larynx. There is more or less hoarseness and impair- 
ment of the voice, and possibly interference with respiration, 
depending upon the location of the cicatricial bands and the 
degree of stenosis. There is usually marked pain and 
dysphagia, with spasmodic cough and scanty expectoration. 
The cicatricial syphilitic stenosis comes on late in the course 
of the disease, so that there usually is the history and 
evidence of other syphilitic lesions. The therapeutic test, 
of course, is valueless. On the other hand, occlusion of the 
larynx by a large papule or a gumma, responds to the 
therapeutic test. 

Cancer may occlude the larynx, but does not often lead 
to cicatricial contraction. 

Tuberculosis of the larynx, also, does not tend to cause 
stenosis through the deposition of cicatricial tissue. The 
chief danger in tuberculosis is from edema. 

Lupus, which may be regarded as a form of chronic 
tuberculosis of the larynx, since it is due to the tubercle 
bacillus, may lead to cicatricial stenosis of the larynx. In 
these cases the mucous membrane is usually anemic, with 
nodules of inflammation here and there. There is usually 
little or no dysphagia or dyspnoea, and there is as a rule 
comparatively little change of the voice. The cicatricial 
stenosis of lupus is usually above the glottis, whereas that of 
syphilis, and also of tuberculosis, is usually below the glottis. 
Furthermore, in lupus stenosis of the larynx, there is often 
lupus of the face. 

Stenosis of the larynx may be caused by trauma. In 
these cases the history is usually amply sufficient to lead 
to a correct diagnosis. Among the traumatic causes are 



Diagnosis of Syphilis. 169 

injuries by foreign bodies, attempts at suicide by cutting 
the throat, and injury by inhaling steam or caustic vapors, 
and swallowing hot or caustic substances. 

Finally, stenosis of the larynx may be congenital, due 
to arrested or faulty development of the larynx. When 
such a stenosis is not complete, the patient may not come 
under observation until later in life. In such cases the stenosis 
is usually due to webs or bands across the glottis, in the 
anterior commissure as a rule; sometimes between the vocal 
cords or the ventricular bands. The diagnosis must be based 
largely upon the history and the absence of other adequate 
explanation of the stenosis. 

Trachea. 

The second and third stages of syphilis have been ob- 
served in the trachea. Syphilides, representing the second 
stage of the disease, are far less common than in the pharynx 
or larynx ; but they are probably more common than the 
reported cases would indicate, since the trachea is not often 
inspected in cases of syphilis. 

Gummata are more frequently reported in this region. 
The diffuse gummata seem to be especially frequent, and 
ulceration is comparatively common in these cases. Perichon- 
dritis and necrosis have been observed in a comparatively large 
number of cases. In this way a number of the cartilaginous 
rings of the trachea may be destroyed. Gross lesions may 
cause great subsequent deformity, through cicatricial con- 
traction and consequent distortion of the trachea. Stenosis 
may be caused by infiltrations or the deposition of scar tissue. 

The severity of the symptoms of syphilitic affection of 
the trachea vary within wide limits, depending upon the 
location and character of the lesion. When large areas 
of the tracheal mucous membrane are involved, especially if 
there is ulceration, there will be increased muco-purulent 
secretion, cough due to a tickling sensation, often tracheal 
rales, and possibly pain behind the sternum. Stenosis of 
the trachea may cause dyspnoea. Suffocation may occur 
from the occlusion of the larynx by necrotic cartilage. Per- 



170 Diagnosis of Syphilis. 

foration of gummata into the mediastinum or the surround- 
ing connective tissue, or into the esophagus or the arch of 
the aorta or the vena cava, may cause serious or fatal se- 
quellae, such as mediastinitis, pneumonia, and hemorrhage. 

Inspection should be attempted in all cases of suspected 
syphilis of the trachea. In the presence of stenosis, the 
voice is altered chiefly through a diminution in its volume, 
and there is more or less dyspnoea, which is usually inspiratory 
in character. There is an absence of the d} r sphagia and 
localized tenderness experienced in stenosis of the larynx. 
The stenosis of the trachea is slow in development, as a 
rule. There is not such marked excursions of the larynx 
as are observed when the stenosis is higher up, in the 
larynx. However, syphilis seems to affect the trachea more 
frequently in the presence of syphilitic lesions higher up 
in the respiratory tract, especially in the larynx, pharynx, 
and the nose. Cicatricial stenosis of the trachea usually 
means syphilis. Differential diagnosis may require the ex- 
clusion of tuberculosis, scleroma, cancer, glanders, and chronic 
nonsyphilitic blenorrhcea. Tuberculosis of the trachea occurs 
almost exclusively late in the course of pulmonary tuberculosis. 
The finding of tubercle bacilli would aid in diagnosis, though 
the two affections may co-exist. In scleroma, the diagnosis 
might be made by finding the rhinoscleroma bacilli. Cancer 
runs a much more rapid course than syphilis. The ulcers 
of glanders are rare in this location. It is probable that 
the only chronic blenorrhoea that might give rise to any 
difficulty in diagnosis is that due to scleroma. In any case, 
great assistance in diagnosis may be afforded by the clinical 
history, the serum reaction and the therapeutic test for syphilis. 

Bronchi. 

Frequently the entire respiratory tract seems irritated 
early in the second stage of syphilis, possibly due to the 
excretion of poisons through the pulmonary mucous membranes. 

The second and third stages of syphilis may produce 
the same changes in the bronchi as have been observed in 
the trachea. The symptoms may be limited to one side 



Diagnosis of Syphilis. 171 

of the chest when a single bronchus is involved, or be bilateral 
in affection of both bronchi, in which event there will be 
a general resemblance to affection of the trachea. This is 
especially true of stenosis. In stenosis of a single bronchus, 
there may be lessening of the respiratory movement upon the 
affected side. 

Lungs. 

During the second stage of syphilis, there are often 
the symptoms of pulmonary syphilides. Frequently one of 
the earliest symptoms of this stage is a pulmonary catarrh. 

The literature would seem to indicate a greater frequency 
of tertiary syphilitic pulmonary lesions. This is probably 
only apparent, since the grave pulmonary lesions of syphilis 
are more frequent during the third stage. These are the 
case of pulmonary gummata, which usually become manifest 
some five to fifteen years after the primary infection. There 
are usually the symptoms of pulmonary catarrh, and an 
increasing difficulty of respiration that comes finally to 
amount to actual dyspnoea. There supervene cough with 
slight expectoration, and pain. These symptoms may persist 
for a comparatively long time, frequently with nocturnal 
exacerbations. The pain is usually slight, and there is little 
or no fever. Percussion may show normal resonance or dull- 
ness. The respiratory sounds may be normal, weakened, 
or there may be bronchial inspiration with diminished expira- 
tion with reduction of the respiratory movement. The 
breaking down of a gumma may result in cavity formation. 
Then the expectoration becomes more copious and there is 
an increase of the dyspnoea, cough and pain. There may 
be hemoptysis, but this is apparently much more rare than 
in tuberculosis. General degradation of the health and strength 
of the patient, with cachexia, announce that the case has 
become one of syphilitic pulmonary phthisis. The scene 
is usually closed by tuberculosis or pneumonia. Often in- 
fluenza plays an important part as a secondary infection. 
There has been remarked a frequent disproportion between 
the physical signs of disease of the chest, in pulmonary 



172 



Diagnosis op Syphilis. 



syphilis, and the subjective symptoms experienced by the 
patient. Thus, severe asthma or dyspnoea may be due to 
enlarged glands, that may not be detected upon physical 
examination ; or these symptoms may be due to stenosis from 
the contraction of scar tissue, which may not be recognized 
by the examiner. Cardiac asthma, due to aortic endarteritis, 
need but be mentioned at this place. 

In the differentiation from tuberculosis, it may be remem- 
bered that syphilis of the lung seems to show a distinct 
preference for the middle of the lungs, and is most frequently 
found upon the right side. But the exemption of the apices 
is not absolute evidence of syphilis ; and, in some cases, syphilis 
involves the apices. The clinical history, the examination 
for the tubercle bacillus, the therapeutic and tuberculin tests 
are all of value. Syphilis shows the Wassermann reaction, 
and it ma}' be possible to find the spirochete pallida in the 
sputum. Unfortunately, tuberculosis and syphilis often co- 
exist, which fact must be well taken account of in differ- 
ential diagnosis. 



PULMONARY SYPHILIS 

May present symptoms resem- 
bling tuberculosis, pneumonia, or 
asthma. In the cases resembling 
tuberculosis, the onset may be sud- 
den or insidious, but the progress 
of syphilitic phthisis is usually 
slower than tubercular phthisis. 

Cough is not so constant nor 
persistent as in tuberculosis. 

Expectoration is less than in ad- 
vanced tuberculosis. 

Hemotysis may occur, but is not 
so common as in tuberculosis. 

Tubercle bacilli may be found in 
the presence of an intercurrent tu- 
berculosis. Syphilis predisposes to 
tuberculosis. 

Elastic tissue may be found when 
there is much breaking down of 
lung tissue, but it is not so common 
nor abundant as in advanced tu- 
berculosis. 



PULMONARY TUBERCULOSIS. 

Mi>^t cases begin with bronchitis. 
Cough, at first dry and hacking, oc- 
curs especially in the morning and 
evening, upon changing posture. 

Expectoration at first absent, be- 
comes abundant; at first mucoid, 
later mucopurulent, and possibly 
containing blood. 

Hemoptysis usually means tuber- 
culosis. 

Tubercle bacillus in the sputum; 
later elastic tissue. 

Frequently the first symptom 
noticed is dyspepsia, often associated 
with anemia, chlorosis, amenorrhoea, 
and general degradation of health. 

Often insidious onset, so that the 
patient does not seek medical advice 
until the disease is far advanced. 

One of the early symptoms is 
shortness of breath upon exertion. 
Later there is dyspnoea, due to 
cardiac weakness, sometimes asso- 
ciated with cyanosis. 

Pain in the chest may be due to 
pleurisy, or to neuralgia caused by 
toxemia. 



Diagnosis of Syphilis. 



173 



Pulmonary Syphilis — Cont'd. 

Dyspepsia is common in syphilis, 
and is benefited by anti-syphilitic 
treatment; such treatment is dis- 
tinctly injurious in the dyspepsia of 
tuberculosis. 

Anemia is usually not so great 
in pulmonary syphilis as in tubercu- 
losis. 

Loss of strength is not so marked 
in pulmonary syphilis as in tuber- 
culosis that is far advanced. 

The onset of tuberculosis is often 
more insidious than syphilis; the 
latter presents extra-pulmonary le- 
sions. 

Night sweats are comparatively 
rare in pulmonary syphilis. Hectic 
is less common, but may occur in 
the presence of a mixed infection, 
as when cavities are filled with pus. 
Loss of weight usually comes on 
later than in tuberculosis, and it is 
not so marked. 

Physical examination will usually 
reveal extra-pulmonary evidence of 
syphilis. Examination of the chest 
reveals various rales, and the evi- 
dence of consolidation or breaking 
down of tissues, much as in tuber- 
culosis. 

Syphilis shows an early preference 
for the lower lobes or root of the 
lungs. (Berg frequently found the 
upper lobe of the right lung in- 
volved. ) 

Doubtful cases justify the thera- 
peutic test with the iodides or prep- 
aration of iodine. 

Wassermann reaction. 

Spirochete pallida. 



Pulmonary Tuberculosis — Cont'd. 

The temperature is at first nor- 
mal or subnormal in the morning; 
shows early a rise sometime during 
the day, usually in the afternoon. 
Night sweats. Hectic; streptococcus 
curve. 

Pulse at first corresponds with 
the temperature; with increased 
weakness becomes rapid, compressi- 
ble and readily influenced by exer- 
cise. 

Loss of weight is often an early 
symptom, and later is marked. 

Physical signs at first are entirely 
absent. Inspection may reveal the 
habitus phthisicus, now regarded as 
evidence of the existence of the dis- 
ease rather than a so-called predis- 
position. 

Palpation : lessened mobility, with 
defective expansion on one or both 
sides. With consolidation, vocal 
fremitus is increased. In cases of 
pleural exudate the vocal fremitus 
is diminished or absent. 

Percussion: defective resonance, 
especially in the region of the 
clavicle In advanced cases, dullness 
from consolidation, or a cracked 
pot sound in the presence of cavities. 

Auscultation: as a rule prolonged 
expiration early in the disease; 
later there are all sorts of rales. 
An important early sign is accentua- 
tion of the second pulmonary valve 
sound. 

The earliest possible diagnosis 
may be made by the use of the 
tuberculin test. The impression 
that this test may be positive in 
syphilis is probably due to the pres- 
ence of tuberculosis in the syphili- 
tics examined. It should be remem- 
bered that the tuberculin test may 
be positive when there is tubercu- 
losis in any part of the body. 

The blood test in tuberculosis 
shows pronounced agglutination and 
lytic action upon the tubercle bacil- 
lus. 



We should not mistake for syphilis of the lung, the terminal pul- 
monary tuberculosis so often observed in the last chapter of syphilis. 
It would seem that Pelton's* case belongs to this category. Such eases 
are to be regarded as secondary tubercular infections of the lung. True 
syphilis of the lung is much more rare. 



*Adult syphilis of the lung, H. H. 
22, 1910. 



Pelton, Medical Eecord, Jan. 



174 Diagnosis of Syphilis. 



Pleura. 



Pleuisy may occur during the second and third stages 
of syphilis. During the second stage it occurs at the time 
of the eruption, as an expression of affection of the pleura. 
During the third stage it occurs most frequently because of 
the presence of gummata in contiguous tissues. 



SYPHILITIC AFFECTIONS OF THE CIRCULA- 
TORY ORGANS. 

Heart. 

Syphilitic affections of the heart have been recognized 
from time immemorial. Virchow declared that many of the 
cases described b} T the older writers as tubercle of the heart 
were probably cases of syphilis. At any rate, all parts of 
the heart may be affected by syphilis. The most frequently 
observed lesions are gumma of the muscle of the heart and 
fibrous syphilitic scars in the myocardium. Both the fibrous 
and the gummatous myocarditis are usually associated with 
sclerosing endocarditis and sometimes with a limited peri- 
carditis. Syphilis of the pericardium is rare in the absence 
of syphilis of the heart. Syphilitic endocarditis may be 
general or practically limited to the valves. The affection 
of the valves may lead to either insufficiency or stenosis. 
Syphilitic involvement of the papillary muscles may favor 
deficiency of the valves. Syphilis of the coronary arteries 
may lead to aneurysm of the heart. These arteries may 
be affected by a syphilitic endocarditis. 

How early may the heart be affected in syphilis? Fre- 
quently during the second stage of syphilis there are attacks 
of palpitation, that possibly may be due to the action of 
syphilitic poison upon the heart. Furthermore, during this 
stage of the disease there ma}' be attacks of cardiac asthma 
or dyspnoea. It is a question whether these symptoms, ob- 



Diagnosis op Syphilis. 175 

served during the second stage of syphilis, are due to the 
action of the syphilitic virus upon the heart or to the syphilitic 
anemia observed in these cases. 

The important syphilitic lesions found in the heart, 
gummata and scleroses, occur in the third stage of the 
disease, several years after the initial lesion. Usually sudden 
death closes the scene before syphilis of the heart is even 
suspected. In other cases there are the symptoms of a chronic 
myocarditis. There may be general weakness, palpitation, 
and precordial anxiety and pain. The cardiac dullness may 
be normal or increased ; the heart sounds may be normal 
or weakened or irregular, and bruits may or may not be 
present. There are the evidences of a weakened circulation, 
notably anemia and cyanosis, oedema and dropsy, frequently 
albuminuria, and sometimes gangrene. Diagnosis is aided 
by the clinical history, and by the therapeutic test, especially 
in the chronic cases due to gummata. Myocarditis in a 
syphilitic should always be considered syphilitic until proven 
otherwise. 

The Wassermann reaction is of value in determining 
the presence of syphilis. Krefting * examined a number of 
cases postmortem. In about a dozen cases of aortic lesion, 
autopsy revealed syphilitic lesions. In these cases, the Was- 
sermann reaction was found in all but one case, in which 
the absence of the reaction was attributed to active anti- 
syphilitic treatment. In another series of eight cases of 
heart lesions, no Wassermann reaction was found, and there 
was no reason to believe that they were syphilitic. From 
the study of his cases, Krefting concludes that a syphilitic 
aortic lesion may become superimposed on an old non-syphilitic 
lesion of the heart. 

It is often essential that the diagnositician be familiar 
with the etiology of the diseases he studies, since the diag- 
nosis, at any rate the presumptive diagnosis, is often strength- 
ened by the exclusion of other possible causes of the disease 



*R. Krefting, Aortainsufficiens og Wassermann's luesreaktion, Norsk 
Magazin for La agevidenskaben, February, 1910. 



176 Diagnosis of Syphilis. 

under consideration. There are many non-syphilitic causes 
of myocarditis, notably the infections, especially : acute artic- 
ular rheumatism, malaria, gout, diabetes, Bright's disease. 
Probably most cases are ascribed to cold, trauma, or strain. 
Myocarditis is frequently due to extension of inflammation 
from the endocardium or the pericardium. The symptoms 
of myocarditis may be overshadowed by endocarditis or peri- 
carditis. 

As a rule the heart is not able to do its work so 
well. Slight exertion causes palpitation and shortness of 
breath. There may be pain in the region of the heart, 
extending to the right arm or the epigastric region. The 
apex-beat, impact of the heart, and the heart sounds are 
weakened, indicating a weak heart. The pulse becomes weak 
and irregular. Frequently the respiratory passages show 
catarrh. Digestion is impaired. All the organs suffer from 
the poor blood supply. The individual is cyanotic. The 
veins of the neck become distended. The diagnosis rests chiefly 
on the evidence of a weak heart and the history or evidence 
of some disease that may play a role in etiology. 

A circumscribed m3 r ocarditis may be caused by embolism 
in the coronary artery or its branches, or by septicemia. 
The disease is often associated with : 

Ulcerative endocarditis, puerperal fever, malignant pus- 
tule, acute articular rheumatism, diphtheria, or typhoid fever, 
and purulent or gangrenous affection of the lungs. 

Acute diffuse myocarditis, whether parenchymatous or 
interstitial, is usually caused by the infections, especially : 
septicemia, typhoid fever, diphtheria, pneumonia, and 
gonorrhoea. 

The diagnosis of the syphilitic character of a myocarditis 
is reached chiefly through the history or evidence of other 
syphilitic lesions and the exclusion of other causes of myo- 
carditis. A gumma might respond to the therapeutic test, 
but there would be no such response in the cases of cardiac 
syphilitic scleroses. The spirochete pallida and the Wasser- 
mann reaction would indicate the presence of syphilis, but 



Diagnosis of Syphilis. 177 

syphilitics are not infrequently the subjects of non-syphilitic 
diseases of the heart. 

As stated, pericarditis may be due to syphilis. Primary 
pericarditis may be due to trauma or causes apparently not 
connected with other disease, such as "taking cold." More 
important, because much more frequent, are the cases of 
secondary pericarditis, which may be caused by the infections 
or by extension of inflammation from contiguous organs, due 
to bacterial invasion or the action of toxins. Non-syphilitic 
pericarditis is most frequently found in association with: 
rheumatism (especially acute articular rheumatism), chorea, 
tuberculosis, pleurisy, endocarditis and myocarditis, pneumonia, 
influenza, scarlatina, septicemia, variola, scorbutus, nephritis, 
gout, cholera, dysentery, erysipelas, diphtheria, cerebrospinal- 
meningitis, haemophilia, hemorrhage diathesis, purpura, morbus 
maculosis, leukaemia, diabetes, cirrhosis of the liver, carcinoma, 
sarcoma, typhus, typhoid fever, intermittent fever, relapsing 
fever, gonorrhoea, phlebitis, osteomalacia, and aneurism (rare). 

The symptoms of pericarditis may be suggestive, but a 
diagnosis can be made only upon physical examination. The 
pericardial friction-sound and the evidence of effusion, espe- 
cially dullness in the fifth intercostal space to the right of 
the sternum, the precordial dullness later assuming the shape 
of the pericardial sac, with the base of the triangle above, 
are characteristic. Aspiration may be necessary to detect 
effusion, and at the same time will reveal the character 
of the effusion. Sometimes aspiration may not detect fluid 
in the pericardium even when present. Differentiation con- 
cerns especially endocarditis, pleurisy, hypertrophy of the 
heart, mediastinal tumors, and irritation or inflammation 
of the stomach. 

The syphilitic nature of a pericarditis is recognized 
through the association or history of other syphilitic lesions, 
the exclusion of other possible causes of pericarditis, the 
Wassermann reaction, possibly by finding the spirochete pal- 
lida, and by an appeal to the therapeutic test in doubt- 
ful cases. 



178 Diagnosis of Syphilis. 

Endocarditis is a secondary process, occurring in the 
course of or following some infectious disease, due to the 
invasion of the endocardium by microorganisms, a number 
of which have been demonstrated, among them the micro- 
coccus pneumonia crouposae, streptococcus pyogenes, staphy- 
loccocus pyogenes aureus, bacillus diphtheria^, the gonococcus, 
and the tubercle bacillus. 

Endocarditis is especially likely to appear in the course 
of, or after : 

Rheumatism, pneumonia, influenza, septicemia (including 
surgical sepsis and puerperal fever) ; also osteomyelitis, peri- 
ostitis, erysipelas, furunculosis, and dysentery, gonorrhoea, 
scarlet fever; less frequently smallpox, measles, typhoid fever, 
syphilis, Bright's disease, and malaria. 

Sometimes even trivial affections (quinsy, mumps) may 
be accompanied or followed by endocarditis. The endocarditis 
may be due to the invasion by the specific microorganisms 
of the infectious diseases, or to secondary infection, or to 
the effect of toxins. In experiments upon animals it has 
been shown that the injection of microorganisms into the 
circulation is not followed by endocarditis unless the heart 
is first subjected to traumatic or chemical injury. This 
would seem to explain the role played by trauma, exposure 
to cold, arteriosclerosis, and atheroma. 

The symptoms usually of most value in diagnosis are 
chill, fever, pain in the region of the heart, palpitation, 
anxiety, headache, insomnia, and dyspnoea. Sometimes the 
semi-recumbent posture assumed by the patient may excite 
suspicion of the presence of endocarditis. Upon physical 
examination the heart's action may be found increased or 
decreased, the apex-beat displaced, the heart dullness increased, 
and there may be murmurs indicative of valvular disease. 
The history or knowledge of the existence of one of the 
infectious diseases may aid in an individual case. Syphilitics 
are especially prone to affection of the aortic valve ; affections 
of the mitral valve are usually rheumatic. 



Diagnosis op Syphilis. 179 



Blood-vessels. 

Syphilitic arteries are probably more frequent than the 
literature would indicate. Syphilis is a prominent cause of 
arteriosclerosis. 

As in the heart, so in the blood vessels, syphilis seems 
to prefer the muscular tissue. Syphilis weakens the blood 
vessels and becomes one of the chief causes of aneurysm. 
In this way syphilis may affect any artery in the body, to 
cause affections so diverse as an aneurysm of the aorta or 
multiple aneurysms of the cerebral vessels. The rupture of 
these aneurysms is a frequent cause of cerebral hemorrhage. 

Syphilitic endarteritis may cause obliteration of the lumen 
of the vessel, thrombosis, aneurysm, or rupture. 

The veins may suffer from syphilis. A chronic phlebitis 
beginning several months after the primary infection, espe- 
cially if the pain shows distinct nocturnal exacerbations, 
justifies the therapeutic test for syphilis. 

It is a pretty good general rule to suspect syphilis in 
all cases of "idiopathic" disease of the blood vessels. In all 
such cases the advisability of making the therapeutic test 
should be considered. 

Blood. 

The laity have long looked upon syphilis as a disease 
of the blood, and , we now know that the spirochete may 
often be found in the blood, and the Wassermann reaction 
depends upon alterations in the serum. 

Various forms of anemia have been observed in syphilis. 
Syphilitic anemia, sometimes called syphilitic chlorosis, may 
occur early in the second stage of the disease. These cases 
sometimes show later leucocytosis or lymphatic anemia. Some 
cases of pernicious anemia have been reported in which the 
clinical history and the therapeutic test would indicate that 
syphilis was a possible etiological factor. However, the 
anemia found in syphilitics does not always respond readily 
"to anti-syphilitic treatment. 



180 Diagnosis of Syphilis. 

Cachexia. 

Cachexia, like anemia, may be caused by syphilis. The 
diagnosis of syphilis in such cases must depend upon con- 
comitant symptoms. Furthermore, it should be remembered 
that a syphilitic may have a cachexia due to some other 
cause. In such cases the syphilis usually adds to the gravity 
of the picture. 

The more prominent causes of cachexia are malaria, 
syphilis, chronic sepsis, phthisis, lead poisoning, cancer and 
infantile scurvy. 

Cachexia strumapriva, due to destruction or removal of 
the thyroid gland, is easily recognized. 

Cachexia may be due to hemorrhage from the nose, lungs, 
gastrointestinal tract (in association with the ankylostoma 
duodenale, ulcer, cancer, hemorrhoids), the female genital 
tract, the bladder, and the various forms of hemorrhagic 
diathesis. 

Insufficient nourishment and bad hygienic conditions are 
often etiological factors. 

Malignant tumors, severe organic disease, poisons, and 
parasites may be factors in causing cachexia. Chronic sup- 
puration is a prominent factor. Spermatorrhoea, lactorrhoea, 
catarrh of the respiratory and alimentary tracts, are sup- 
posed to be causes. The role played by albuminuria and 
fever is rather to be ascribed to the diseases causing these 
conditions. The animal parasites probably produce cachexia 
through the elaboration of toxins. Among the poisons, lead 
and arsenic are the chief cause of cachexia. 

Syphilitic cachexia may be recognized by the presence 
of the Wassermann reaction. Other evidences of syphilis 
usually abound, relics of existing or preeisting stages of 
the disease. 

Amyloid Degeneration. 

Tuberculosis and syphilis and prominent causes of amyloid 
degenration. The degeneration sems to depend upon the 
presence of chronic suppuration. The parts most frequently 



Diagnosis op Syphilis. 181 

showing amyloid degeneration are the liver, spleen, kidney, 
lymph glands, muscles and fat tissue, and in the mucous mem- 
brane of the gastrointestinal, respiratory, less frequently of 
the urinary tract. 

In the presence of an affection marked by chronic sup- 
puration, the occurence of painless swelling of the liver and 
spleen, albuminuria, and paleness of the skin and mucous 
membranes, suggests the diagnosis of amyloid degeneration. 
The liver, spleen and kidneys are the organs most frequently 
affected. But almost every part of the body may be involved. 
The less frequent locations of amyloid degeneration are the 
intestine, stomach, lymph glands, pancreas, adrenals, and rarely 
the muscles, ovaries, uterus and respiratory tract. 

Syphilis and tuberculosis are the more common causes. 
But amyloid disease gems to depend upon chronic suppura- 
tion in some part of the body. It occurs in the various cach- 
exias, in chronic dysentery, and in leukaemia. 

From what has been said, it is evident that we would not 
expect to find amyloid degeneration dependant upon syphilis 
during the first stage of the disease, nor in the second stage, 
except in the presence of prolonged suppuration. It is most 
common in the third stage of syphilis, when the history and 
relics of the disease usually makes clear the probable syphilitic 
nature of the process. 

In all cases of amyloid degeneration, we should look 
for a chronic suppuration. Syphilis is a prominent cause, 
both hereditary and acquired syphilis. Vieing with syphilis 
in frequency is chronic tuberculosis. 

Amyloid degeneration due to syphilis seems to affect 
with especial frequency the blood vessels, especially the small 
arteries and capillaries, less often the veins. With this 
there is also amyloid degeneration of the spleen, liver, kidneys 
and intestine. 

Amyloid degeneration of the spleen is marked by enlarge- 
ment of the organ and a feeling of fullness. 

Involvement of the liver in the amyloid disease causes 
a firm enlargement of the organ, with a feeling of fullness 



182 Diagnosis op Syphilis. 

and pressure. Usually there is no icterus. There may be 
ascites, usually due to hydremia. Fatty liver may cause some 
confusion in diagnosis at times ; the presence of amyloid dis- 
ease in other organs may assist in differentiation. 

Amyloid disease of the kidneys usually does not cause 
a reduction in the quantity of urine. Albuminuria is fre- 
quently pronounced. As a rule the urine is clear and the 
specific gravity seems to depend upon the quantity passed. 
Casts are few or absent. Edema or ascites may be present, 
due to hydremia. Uramia is rare. Hypertrophy of the 
heart, such as is present in contracted kidney, is not caused 
by amyloid disease of the kidney. 

Amyloid disease of the intestine causes anorexia, periodical 
vomiting, and pale stools, containing mucus. 

In any case of amyloid disease, the diagnosis of syphilis 
must rest upon other evidence of the presence of the disease. 
The outlook, in cases of amyloid disease, is always grave, 
though possibly a cure may be secured early in these cases, 
when there has occurred only slight degeneration. 



SYPHILITIC AFFECTIONS OF THE GLANDS. 

Lymphatic Glands. 

The neighboring lymphatic glands show enlargement as 
the rule soon after the appearance of the initial lesion. 
Usually the lymphatics are enlarged, as well as the glands, 
in the lymphatic system leading from the region in which 
the chancre occurs. Occasionally the first line of lymphatics 
are spared and more remote glands are affected ; or the glands 
may appear enlarged upon the opposite side of the body, 
for instance, when the lesion is near the middle line. These 
occurrences, which must not be regarded as the rule, are 
explained by the anastomoses of the lymphatics. During 
this period, the buboes must be differentiated from those 
of chancroid ulcer and gonorrhoea, less frequently from the 



Diagnosis op Syphilis. 183 

lymphatic gland enlargement of tubercle and cancer. Eczema 
and prurigo may also cause adenopathies. Finally, it must 
be remembered that simple infected sores may lead to an 
enlargement of the neighboring lymphatics. 

The spirochete pallida may be found in smears from 
extirpated syphilitic glands, or from the gland juice ob- 
tained by puncture. 

During the second or irritative stage of syphilis, the 
adenopathies assume prominence. During this stage, the 
enlargement of the lymphatics will usually be explained by 
finding syphilides in the region from which the lymph flow 
is derived. Occasional apparent deviations from this rule 
are explained by lymphatic anastomoses. Enlargement of 
the cervical lymphatics would suggest the probability of a 
secondary syphilitic lesion in the periphery from which these 
lymphatics are derived, such as in the ear, nose, nasopharynx, 
mouth, or an eruption upon the scalp. Affection of the 
cubital and axillary lymphatic glands should lead to an exami- 
nation of the hands and arms. The mediastinal, abdominal 
and pelvic lymphatic glands are enlarged especially in syph- 
ilitic affection of the intestine. 

Scrofula is usually syphilis or tuberculosis. It may be 
due to other causes, such as leprosy, glanders, etc., but they 
are less common with us. 

During the third stage of syphilis, gummata and syphilitic 
scars are usually marked by little or no affection of the 
lymphatics. However, an infected gumma may lead to en- 
largement of the lymphatics, the lymphadenopathy being 
due to the secondary infection, which is usually septic in 
character. 

Gummata of the lymphatics have been occasionally observed. 

Clinically, the lymphatic vessels seem to be affected more 
during the first than during the second stage of syphilis. 



184 Diagnosis op Syphilis. 

DIAGNOSIS OF BUBOES. 
Syphilis. 

(First stage). 

Buboes show a tendency to be indolent, in the absence 
of secondary infection. 

Presence of chancre in region drained by lymphatics that 
empty directly or indirectly into the affected glands. 

Syphilitic buboes are usually multiple. 

Little pain or discomfort, save when there is mixed infection. 

Glands not greatly enlarged, in the absence of mixed 
infection. 

Cartilaginous induration. 

Absence of inflammatory symptoms. 

Glands remain freely movable. 

Slow course. 

Tendency to resolution. 

Occur soon after appearance of chancre. 

Benefited by mercury. 

Auto-inoculation from the pus of suppurating syphilitic 
buboes rarely if ever occurs, save in the presence of mixed 
infection. 

(Second stage). 

Syphilides may be found in the region drained by lym- 
phatics that empty directly or indirectly into the affected 
glands. 

(Third stage). 

An infected gumma may lead to adenopathy, due to 
the secondary infection. Lymphatic gummata are rare. 

In all stages of syphilis, the spirochete pallida and the 
Wassermann reaction are important factors in diagnosis. 



Diagnosis op Syphilis. 185 



Inflammatory Buboes. 

Occur in about one-third of the cases of chancroid; less 
frequently in herpetic or balanitic ulceration or gonorrhoea; 
and may be due to infected wounds anywhere in the region 
drained by the lymphatic glands that empty into the affected 
glands. Thus an ingrowing toe-nail may cause enlargement 
or suppuration of the inguinal lymphatic glands. 

Usually single, occasionally double, rarely multiple. 

More prone to suppurate than syphilitic buboes. 

Painful. 

Usually cause greater enlargement of glands than syphilis. 

Inflammatory hardness. 

Inflammatory symptoms present. 

Periadenitis causes the gland to become fixed. 

Often adherent to skin; and the skin is often reddened. 

Course more acute than in syphilis. 

Tendency to suppuration. 

Not benefited by anti-syphilitic treatment; require local 
treatment. 

The pus from chancroidal buboes is infectious and causes 
auto-inoculation. 

The spirochete pallida and Wassermann reaction are ab- 
sent, except in the presence of syphilis. 

The venei'eal diseases, like vices, are gregarious. Mixed 
infections are not uncommon. The sphilitic patient enjoys 
no immunity from inflammatory buboes. 



186 Diagnosis of Syphilis. 

Tuberculous Buboes. 

Tendency to caseation. 

Presence of source of infection in region drained by 
lymphatics that empty directly or indirectly into affected 
glands. 

Usually multiple. 

Usually little pain or discomfort except when there is 
mixed infection. 

Usually the glands become considerably enlarged; rarely 
there is little enlargement of an infected gland. 

Caseation and softening may be recognized by palpation. 

Inflammatory symptoms are usually absent, except when 
there is secondary infection. 

The affected glands may be freely movable, or they may 
become fixed by involvement of the peripheral parenchyma. 

The course may or may not be slow ; the infection may be 
confined to the affected glands, or it may spread to other 
parts of the bod} 7 through the breaking down of these glands. 

Usually there is no tendency to resolution. 

Occurs three to six weeks after infection of the region. 

Not benefited by anti-syphilitic treatment ; responds to 
the tuberculin test, and is benefited by treatment of tuber- 
culosis. 

In localized tuberculosis upon one side of the body (in- 
guinal region, ear, or eye) it is common to find affection of 
the glands upon the same side, and also upon the opposite 
side, though to a slighter degree. 

The importance of the lymphatic distribution of tuber- 
culosis is often underestimated. Tuberculosis of the toe may 
lead to caseation of the popliteal, inguinal and retroperitoneal 
glands, tuberculosis of the liver and spleen, and finally tuber- 
culosis of the lungs and caseation of the bronchial glands. 

Tuberculosis of the nose will cause caseation of the cervical 
glands, tuberculosis of the lungs and caseation of the bron- 
chial glands, and later tuberculosis of the liver and spleen. 

The skin and mucous membranes offer a barrier to infec- 



Diagnosis of Syphilis. 187 

tion, but when the infection passes the barrier thus imposed, 
it is readily carried by the lymphatics to cause adenopathies. 

Glandular tuberculosis shows a preference for early life, 
most cases occurring before the tenth year. Most of the re- 
ported cases have occured in females. These preferences are 
attributed to increased susceptibility, diminished power of re- 
sistance, and unfavorable conditions of living. 

Gland tuberculosis shows a strong preference for the cervical 
and bronchial glands ; the preauricular and postauricular 
glands are less often involved, and much less frequent is 
tuberculosis of the axillary, cubital, inguinal, and popliteal 
glands. 

The cephalic lymph vessels convey infection from the skin 
of the head, the eyes, ears, nose, mouth, throat, palate, and 
tonsils, to the various glands of the neck, the auricular, cerv- 
ical, and submaxillary glands, as well as the glands of the 
supraclavicular and infraclavicular regions. 

Tuberculosis of the conjunctiva, cornea, or iris involves 
first the lymph glands in the region of the ear, jaw, and neck, 
especially or exclusively upon the diseased side. 

Inguinal adenopathies are rarely due to tuberculosis of 
the bones and joints of the foot; they are the rule in tuber- 
culosis of the vulva, vagina, or portio ; and of the penis or 
testicles. In such cases there may be an extension of the 
adenopathy to the retroperitoneal glands. 

In diagnosis, it is well to remember that a latent tuber- 
culosis may be made active, or the individual's immunity to 
tuberculosis may be lessened by the infectious diseases that 
are associated with catarrh of the respiratory tract, notably 
measles, croup, scarlet fever, diphtheria, influenza; and also 
by any disease that may lower the general resistance, such as 
typhoid fever. 



188 Diagnosis of Syphilis. 



Cancerous Buboes. 

Indolent before ulceration; may be inflammatory from sec- 
ondary infection after ulceration. 

Presence of cancer in the region drained by the lymphatics. 

Usually multiple. 

At first there is little or no pain in the glands before 
ulceration ; later there may be pain from the pressure of the 
enlarged glands, or from secondary infection after ulceration. 

Glands become greatly enlarged. 

Marked induration. 

Inflammatory symptoms absent before ulceration ; may be 
present after ulceration unless prevented by treatment. 

Glands at first movable, later become fixed. 

Course usually more rapid than in syphilis. 

No tendency to resolution. 

Occur soon after appearance of cancerous nodule. 

Not benefited by anti-syphilitic treatment ; sometimes show 
temporary improvement under very large doses of the iodides. 

The pus is comparatively non-irritating, except in the 
presence of mixed infection. 

Prefers mature and advanced age. 

If the patient is not syphilitic, the spirochete pallida will 
be absent. Spirochetes may be found in cancer, but they are 
not the spirochete pallida. 

The Wassermann reaction is absent, except in syphilis. 
Syphilitics are not exempt from cancer. 



Diagnosis op Syphilis. 189 



Buboes in Leprosy. 

Indolent buboes ; may be inflammatory through secondary 
infection of ulcers. 

The adenopathies of leprosy are pretty general, resembling 
the second rather than the first stage of syphilis. The affec- 
tion of the glands in the inguinal region is usually most 
pronounced. 

Usually multiple. 

Little pain or discomfort, in the absence of mixed infec- 
tion ; later they become large and painful. 

The size of the glands varies, probably corresponding to 
the amount of virus present in the body. The inguinal glands 
may attain the size of a goose egg, and any of the glands 
may become engorged ; the cervical and axillary glands are 
often large, and the submaxillary and sublingual glands may 
become so large as to interfere with mastication and deglutition. 

Indurated. 

Absence of inflammatory symptoms. 

Glands freely movable at first; later may become adherent. 

Slow course. 

No tendency to resolution; usually the affection of the 
glands increases with the progress of the disease. 

May be observed early in the course of leprosy. 

Not benefited by anti-syphilitic treatment. 

Softening and ulceration are rare ; late cases may show 
fistulas that discharge large quantities of thick matter that 
is comparatively non-irritating.. 

The spirochete pallida will not be found, and the Wasser- 
mann reaction is negative, save when there is a concomitant 
syphilis. 



190 Diagnosis of Syphilis. 



Buboes in Glanders. 

Tendency to suppuration. 

Point of inoculation in the region drained by the lym- 
phatics. 

Usually multiple. 

Marked pain and discomfort. 

Comparatively slight enlargement of the glands. 

Inflammatory induration, soon followed by softening. 

At first movable, before suppuration and breaking down. 

Usually rapid course, two weeks ; the chronic form of 
glanders, which may last for months or years, does not show 
much involvement of the lymphatics. 

Tendency to suppuration. 

Occur soon after infection. 

Not benefited by anti-syphilitic treatment. 

Mallein test of value. 

Spirochete pallida absent. 

Wassermann reaction negative. 

There is often a history of exposure to the infection. 

Bacteriological examination reveals the bacillus mallei, to 
make the diagnosis absolute. 



X 



Diagnosis of Syphilis. 



191 



Syphilitic Lymphangitis. 

1. The affected lymphatic vessels 
feel harder than in cases of in- 
flammatory lymphangitis. 

2. The lymphatic vessels are not 
especially tender, and show a gen- 
eral absence of inflammatory symp- 
toms. 

3. Penile erections are not pain- 
ful, and the skin overlying the af- 
fected lymphatic vessels remains 
apparently normal. 

4. Syphilitic lymphangitis al- 
most always terminates in resolu- 
tion. 

5. Syphilitic lymphangitis does 
not require local treatment, and 
disappears under the usual mercu- 
rial treatment. 

6. Spirochete pallida and the 
Wassermann reaction are present. 

7. There may be the history or 
other evidence of syphilis. 



Inflammatory Lymphangitis. . 

1. Lymphatic vessels tender, but 
not so hard as in syphilitic lym- 
phangitis. 

2. Inflammatory lymphangitis is 
marked by tenderness of the af- 
fected vessels, and inflammatory 
symptoms. 

3. Erections are painful, and the 
skin is reddened over inflamed 
lymphatic vessels. 

4. Inflammatory lymphangitis 
frequently undergoes resolution, but 
may terminate in suppuration. 

5. Inflammatory lymphangitis is 
greatly benefited by local treat- 
ment, and does not require the 
anti-syphilitics. 

6. Absent in inflammatory lym- 
phangitis, except in syphilitics. 

7. Absent, unless there is a con- 
comitant syphilis. 



192 Diagnosis of Syphilis. 

Spleen. 

Syphilis ranks with malaria and tuberculosis among the 
chronic infections that may affect the spleen. Acute enlarge- 
ment of the spleen may occur in the second stage of syphilis. 
Chronic enlargement of the spleen is common in hereditary 
syphilis, in which the involvement of the spleen is next to that 
of the bones in frequency. The hyperplastic enlargements of 
the spleen may be soft or indurated. These are the two forms 
distinguished by Virchow. Further, the spleen may be en- 
larged by amyloid change. 

Gummata of the spleen are comparatively rare, and usually 
are associated with syphilis of the liver. 

The spleen may be enlarged while the patient is still suf- 
fering from the initial lesion. Furthermore, the spleen may 
be enlarged from non-luetic causes, such as malaria, any time 
during the course of syphilis. An enlarged spleen sometimes 
undergoes reduction in size under the therapeutic test for 
syphilis. In such cases a presumptive diagnosis of syphilitic 
enlargement of the spleen may be made, though such a reduc- 
tion may at times occur in non-syphilitic cases. The clinical 
history is of value as a side light in the diagnosis of obscure 
cases. The presence of the Wassermann reaction indicates 
syphilis, but does not exclude the other causes of enlargement 
or affection of the spleen. 



Thymus Gland. 

Cases of syphilitic affection of the thymus gland have 
been reported from time to time, but the affection is so rare 
that the diagnosis must rest largely upon the clinical history 
of the case, and the result of the therapeutic test in suspected 
cases. The most marked changes have been hyperplasia and 
induration. The presence of syphilis may be recognized by 
the Wassermann test, and by the evidences of the disease in 
other parts of the body. 



Diagnosis op Syphilis. 193 

Simmonds declares that macroscopic cyst formation together 
with an increase in the epithelioid structure of the thymus, 
may be taken as a sign of congenital syphilis. Congenital 
syphilis is manifested in the thymus gland by an increase of 
the epithelioid cells, which are found either in columns, or 
canals, or surrounding microscopic spaces, vacuoles. In a 
few instances the epithelioid cells have been found in such 
abundance and the lymphoid structure has been so scarce and 
Hassal's corpuscles have shown such paucity that the entire 
structure of the gland has been altered. In these cases macro- 
scopic cysts may form, which contain a serous fluid, lymphoid 
cells, or purulent material. In these cases, the spirochete pal- 
lida may be demonstrated in the contents as well as in the 
cyst wall. 

THYMUS GLAND. 

Chiari, Zeitschrift fiir Heilkunde, xv, 403, 1894. 

Eberle, Ueber kongenitale Lues der Thymus. 

Kaufmanns, Lehrbuch der pathologischen Anatomie, iv. Aufl. 1907, 
s. 316. 

Schlesinger, Arehiv fiir Kinderheilkunde, xxvi, 205. 

*Simmonds, M., Die Thymus bei kogenithaler Syphilis, Arch. Path. 
Anatomy, Band 194, p. 213, 1908. 

Tuve, Ueber die sogenannten Duboisschen Thymusabszesse, Disserta- 
tion, Leipzig, 1904. 

Thyroid Gland. 

Syphilitic patients not infrequently show enlargement of 
the thyroid gland. But the enlargement is not always due to 
syphilis. Syphilitic patients are as liable as the non-syphilitic 
to non-luetic enlargement of the thyroid. Furthermore, the 
positive therapeutic test for syphilis is not always to be 
relied upon in these cases, since non-syphilitic enlargement of 
the thyroid will frequently respond to this test. 

In congenital syphilis, gummata of the thyroid has been 
observed, in association with syphilitic lesions in the viscera 
and other parts of the body, especially the thymus, lung, liver 
and pancreas. Gumma of the thyroid has also been observed 
later in life, usually in association with visceral involvement. 
Clinically these cases present a tumor of varying size, not 



194 Diagnosis of Syphilis. 

adherent to the skin, but possibly firmly adherent to the trachea 
and larynx, and without metastases. Ulceration may occur, 
and pressure on the trachea may lead to edema of the larynx 
and difficulty in deglutition. Hoarseness is a common symptom. 
Interference with the function of the thyroid may lead to 
myxedema. There may be the symptoms of exophthalmic 
goitre. 

Enlargement of the thyroid is often observed during the 
second stage of syphilis, frequently as an early symptom. 
Such syphilitic goitres, which respond favorably to anti- 
syphilitic treatment, should be distinguished from the swelling 
of the thyroid in syphilitics, due to the anti-syphilitics and 
made worse by these remedies. 

THYROID. 

Barth and Gombault, Progres Med., 1884, xii, 834. 

Birch-Hirsclifeld, Lehrlmch der speciellen pathologischen Anatomie, 
Berlin, 18S7, i, 578. 

Clarke, Lancet, 1897. ii. 389. 

Davis, B. F., Syphilis of the thyroid. Archives of Internal Medicine, 
xxxix, vol. v. No. 1, January 15, 1910. 

Demme, Krankheiten der Schilddriisen. Bern, 1897 ; Gerhardt's Hand- 
buch der Kinderkrankheiten, iii, part 2, p. 413. 

Engel-Reimers, Jahrb. d. Hamburg, Statskrankenanst., 1891-92, ii. 
430-436. 

Fraenkel, Deutische med. Wochenschrift, 1887, xiii, 1035. 

Fiirst, Moritz, Berlin klin. woch., 1898, xxv, 1016. 

Julien, Traite pratique des maladies veneriennes, 1899, p. 642. 

Kohler, Berlin klin, Wochenschrift, 1892, xix, 125. 

Lancereaux, Traite historique et pratique de la syphilis, 1868. i, 377. 

Lang, F., Jahresbuch d. Gesellsch. f. Natur. und Heilk., in Dresden, 
1851-52. 

Lockwood. St. Bartholomew's Hosp. Reports, 1895, xxi. 232. 

Mauriac, Syphilis primitive and svphilis secondaire, 1890, p. 474. 

Mendel. Me'd. Klin., Berlin, 1906, ii. 833. 

Navratil, Chir. Beitr.. Stuttgart, 1882, pp. 21, 22. 

Power and Murphy. A system of syphilis, 1908, ii. 169. 

Richardson, The thvroid and parathvroid glands. 1905. 

Thursfield. Brit. Med. Jour., 1908, i,* 147. 

Wagner, Arch. d. Heilk.. iv. 

Wermann, Berlin, klin. Wochenschrift. 1900. xxxvii, 122. 

Ziegler, Text-book of Special Pathological Anatomy. 

Davis has recently reported a case of syphilis of the 
thyroid, in which the diagnosis was confirmed by the histo- 
logical findings. He gives a resume of twenty cases from the 
literature, eight, of these were diagnosticated clinically with- 



- 



Diagnosis of Syphilis. 195 

out any recorded anatomic proof of the correctness of the 
diagnosis. Three cases were diagnosticated both clinically 
and histologically. Eight cases were diagnosticated histo- 
logically. One other case was probably diagnosticated only 
clinically. 

Davis claims that the case he reports is the first case of 
gumma of the thryoid in which the diagnosis was confirmed 
by the anatomical findings, to be reported in American litera- 
ture, the third in the English language, and the eleventh in 
the entire medical literature. 

Supraneal Bodies. 

Gummata or gummatous degeneration have been observed 
in the adrenals in some cases of Addison's disease. The pos- 
sibility of such an occurrence would be suggested by the 
association of syphilis and Addison's disease, especially if the 
former antedated the latter. The Wassermann reaction and 
the therapeutic test would make the diagnosis. 

Syphilis of the Breast. 

Chancre of the breast occurs almost exclusively as the 
result of nursing an infected infant, the nipple or areola 
being infected usually by a child with mucous patches in the 
mouth. Often a fissure or abrasion of the nipple exists, favor- 
ing infection. The examination of the child's mouth will 
often suggest the diagnosis. Though the mother may be 
protected from infection by her own syphilitic child, a nurse, 
who is not the mother of the child, enjoys no such immunity. 
Infection may also be received from other sources. When due 
to nursing a syphilitic child, multiple chancres, sometimes in- 
volving both breasts, are not uncommon. 

The chancre presents the general appearance of that lesion, 
indurated base, with axillary or cervical adenopathy. The 
lymph glands in the axilla and above the divide are enlarged, 
and often the inflamed lymphatics may be traced with the 
finger, or even with the eye, the perilymphangitis causing a 



196 Diagnosis of Syphilis. 

distinct cord or possibly color lines. Induration remains at 
the site of the inoculation long after the chancre has healed 
and the adenopathies have disappeared. 

Chancroid is not so common in this localitj', and is marked 
by its auto-inoculability. 

The second stage of syphilis is manifested in the breast 
chiefly in the form of mucous patches and moist papules. The 
secretions from these lesions are infections, so that not infre- 
quently there is presented a picture much resembling that of 
chancroid. This is especially true in obese women with large, 
pendulous breasts, the region beneath the breast being espe- 
cially liable to affection. The other syphilides, such as the 
pigmentary syphilide, may be found upon the skin of the 
breast as elsewhere. Evidences of the disease in other parts 
of the body affords an aid to diagnosis. 

In the third stage of syphilis, the breast may be affected 
by gummata, either circumscribed or diffuse, the so-called 
syphilitic mastitis. 

The circumscribed gumma presents an indolent swelling, 
without change in the color of the skin, marked by the ab- 
sence of pain and the presence of axillary adenopathy. Usually 
both breasts are affected. 

Diffuse gummata in this region are subcutaneous or in 
the tissue of the gland. They are of slow growth, indolent, 
and often discovered only upon palpation. Later the mass 
breaks down in its center, becomes adherent to the skin, which 
shows a change in color. Ulceration ensues, with the discharge 
of the broken-down tissue, and healing takes place with de- 
formity. Such growths bear a marked resemblance to cancer 
of the breast. 

All stages of syphilis show the Wassermann reaction, ex- 
cept where it is obscured by anti-syphilitic treatment. The spi- 
rochete may be found, and is of special diagnostic value in the 
first and second stages of the disease. But a syphilitic may 
be affected by cancer of the breast, so that when in doubt, the 
therapeutic test is often of value. 



Diagnosis of Syphilis. 197 

SYPHILITIC AFFECTIONS OF THE URINARY 
ORGANS. 

Kidneys. 

Acute, subacute, or chronic nephritis, granular kidney, 
gummatous infiltration, and amyloid kidney may occur in the 
course of syphilis. Perinephritis and paranephritis have also 
been observed. Various combinations of these affections may 
exist. Thus amyloid disease and contracted kidney are held 
by some observers to be characteristic of syphilis. Statistics 
would indicate that amyloid disease is from seven to ten or 
more times more frequent than gummata of the kidney. Gum- 
mata are apparently comparatively rare in the kidneys in 
hereditary syphilis. All of these affections of the kidneys, 
save gummata, may be found in the absence of syphilis. 

The kidney may be affected during the second and third 
stages of syphilis. The Bright's disease of syphilis may be 
infectious or syphilotoxic in character. Improvement under 
anti-syphilitic treatment would speak for the syphilitic nature 
of a nephritis. Further than this, the clinical history of the 
case may be of value in diagnosis. It must be remembered, 
however, that a syphilitic patient may have a nephritis from 
other causes. Sometimes albuminuria and cylindruria occur 
during mercurial treatment, to disappear after the remedy is 
stopped. 

Amyloid kidney may be caused by other diseases than 
syphilis, such as tuberculosis. There is usually albuminuria, 
and frequently amyloid disease may be present in other organs, 
especially the spleen and liver. The syphilitic origin of the 
amyloid disease may be inferred from the clinical history. 

Gumma is the only characteristic syphilitic lesion of the 
kidney. One or both kidneys may be affected. A unilateral 
affection, especially in the presence of gummata in obher 
parts of the body, is most characteristic. However, in such a 



198 Diagnosis op Syphilis. 

case Lang made a false diagnosis of gumma of the kidney in a 
case of echinococcus cysts, the peresites being later voided in 
the urine. 

Haematuria, marked by the passage of bright blood, has 
been observed in syphilis. The disappearance of the bleeding 
under the use of the iodides would seem to speak for the 
syphilitic nature of the hemorrhage. However, pain without 
haematuria is probably more characteristic of renal syphiloma. 

Obscure cases of renal disease may occasionally be cleared 
up absolutely by the microscopic examination of the urine, 
which may reveal pieces of a gumma or of amyloid material. 

Haemoglobinuria has occasionally been observed in syphilis. 
Sometimes the affection is periodical. It is possible that the 
haemoglobinuria may be caused by syphilis. Incidentally it 
may be mentioned that the affection has been attributed by 
some to the use of mercury. 



Ureter. 

Gumma of the ureter has been reported. There was dila- 
tation of the kidney and ureter above the obstruction ; and 
gummata were found in the liver and spleen. 



Bladder. 

Ulcers have been observed in the bladder, which were ap- 
parently due to syphilis. Such syphilitic ulcers have been 
described by Virchow, Tarnowsky, Proksch, etc. In the re- 
ported cases, in which the diagnosis was made ante-mortem, 
the patients have shown other symptoms and evidences of 
syphilis with the symptoms of vesical ulceration. The patients 
have ranged in age from childhood to Virchow's case, a woman 
eighty-four years old. With the modern cystoscope, there is 
no reason why such cases should not be recognized. 






Diagnosis of Syphilis. 199 

Uretha. 

The primary sore is the most frequent syphilitic affection 
of the urethra. In this location, the chancre not infrequently 
assumes the slate-pencil shape. The condition is to be dif- 
ferentiated chiefly from gonorrhoea, chancroid ulcer, and sim- 
ple stricture of the urethra. 

The second stage of syphilis is probably not infrequently 
represented by an eruption of syphilides in the urethra, which 
have been observed occasionally through the endoscope. In 
such cases the mucous membrane of the urethra is found 
inflamed in circumscribed spots, sometimes circular in form, 
marked by increased redness, swelling, and a greater secretion 
of mucus. There may be found a papular syphilide or a 
circumscribed erosion. There is often not much increased secre- 
tion of mucus, which seems to depend largely upon the degree 
of infiltration. The possibility of urethral herpes must be 
borne in mind. 

The third stage is more frequently reported than the 
second stage, though not so frequent as the first stage of 
syphilis of the urethra. During this stage there may be 
gummata of the urethra, which may break down to form 
ulcers, and lead later to cicatrization. The presence of nodules 
or ulcers or scar tissue may be observed through the endo- 
scope. The gummata and gummatous ulcers respond to the 
therapeutic test. The syphilitic nature of the scars may be 
inferred from the history of the case. Sometimes the gummata 
break down and lead to the formation of fistulas. Any part 
of the urethra may be affected by syphilis. Pain varies in 
severity, and may be absent altogether. Differential diagnosis 
calls for the separation of syphilis from cancer and tuber- 
culosis of the urethra. The history, Wassermann reaction, 
therapeutic tests, examinations of the secretion, and possibly 
the microscopic examinations of particles of the tissue make 
the diagnosis. 



200 



Diagnosis op Syphilis. 



Urethral Chancre. 

1. Incubation from ten to forty 
days, usually two or three weeks. 

2. Located at or near the mea- 
tus. 

3. Absence of chordee; ardor 
urinae felt only at meatus. 

4. Scanty discharge, serou9 or 
sero-sanguinolent ; may become 
purulent only as result of second- 
ary infection. 

5. Induration usually involving 
one lip of meatus; sometimes in- 
volving the entire meatus, when 
the induration may be pencil 
shaped. 

6. As a rule the inguinal lym- 
phatics present multiple indolent 
buboes. 

7. Visual examination reveals 
an ulcer. 

8. Microscopic examination reveals 
the spirichsete pallida. The Was- 
sermann reaction is present. It is, 
of course, possible for urethral 
chancre and gonorrhoea to co-exist. 

9. The use of the penile syringe 
causes pain at the meatus. 

10. Subsequent constitutinal symp- 
toms. 



Gonorrhoea. 

1. Incubation from one day to 
one week, rarely longer. 

2. Extends from meatus back- 
ward, and may involve any part of 
urethra. 

3. Chordee common ; ardor urinse 
may be felt along the entire 
urethra. 

4. Copious discharge, purulent 
and irritating, comparatively rare- 
ly stained with blood. May become 
laudable when ulcer is healing. 

5. No induration, save such as 
may be due to inflammation, irri- 
tation, or caustics, and it is then 
more temporary and not so hard, 
firm and elastic as the induration 
of chancre. 

G. Buboes are usually absent; 
when present they are usually 
single and tend to suppurate. 

7. No ulcer; visual examination 
reveals only an inflammation. 

8. Microscopic examination reveals 
gonococci, especially in early cases. 
So-called chronic gonorrhoea is often 
a septic urethritis, due to the 
ordinary pyogenic micro-organisms. 

9. As a rule the use of the 
syringe is not accompanied by 
pain. 

10. Gonorrhoea remains a local 
disease. 



Diagnosis op Syphilis. 



201 



Chancroid. 

1. Short incubation, usually a 
number of hours, rarely longer 
than two days. 

2. Located at or near the mea- 
tus; rarely extends beyond the 
fossa navicularis. 



3. Chordee usually absent; there 
may be ardor urinae at the meatus. 

4. Discharge abundant, purulent, 
irritating. 

5. Little or no induration. 

i*i. The lymphatic glands are af- 
fected in about one-third of cases; 
the affected glands usually sup- 
purate, and the pus from them is 
infectious, causing autoinoculation. 

7. Visual examination will reveal 
the characteristic clean cut irregu- 
lar ulcer. 

8. Microscopic examination may 
reveal the bacillus of Ducrey or 
the ordinary pyogenic micro-organ- 
isms, especially the streptococcus. 
It is not uncommon for the various 
genital infections to co-exist. 

9. The use of the penile syringe 
is painful at the meatus. 



10. Chancroid remains a local 
disease. 



Stbictueb. 

1. Occurs after some injury or 
disease of the urethra; rarely con- 
genital. 

2. Possibly may occur anywhere; 
most frequent in the region of the 
bulb, in the region of the peno- 
scrotal angle, and posterior to the 
fossa navicularis. 

3. No chordee; there may be ob- 
struction to flow of urine but no 
ardor urinse. 

4. There may be a gleety dis- 
charge and shreds in the urine. 

5. Little or no induration. 

6. No affection of lymphatics, 
save such as may be due to coin- 
cident or preceding disease. 



7. No ulcer; examination will re- 
veal the stricture. 

8. There is no characteristic 
microscopic evidence of stricture; 
there may be evidence (gonococci, 
streptococci, etc.) of a co-existing 
disease, that possibly may have 
played a role in the etiology of 
the stricture. 

9. Usually the use of the penile 
syringe is not painful. The stric- 
ture may be recognized by the 
obstruction offered to the passage 
of a sound or catheter. 

10. Stricture is a local condi- 
tion; the obstruction offered to the 
outflow of urine may lead to 
changes higher up the urinary 
tract, especially cystitis. 



202 Diagnosis op Syphilis 



Urethral Syphilides — Urethral Herpes. 

Herpes progenitalis may occur in the meatus or urethra, 
hut it is more frequently found in males in the sulcus behind 
the corona, and sometimes on the glans ; in females, upon the 
labia, the hood of the clitoris, the vagina, and the cervix 
uteri. The patient complains of itching and burning, and 
there may be some edema of the affected parts, especially 
when the prepuce or labia is affected. Upon mucous mem- 
branes, the vesicles soon rupture, leaving small superficial 
ulcers. 

In differential diagnosis, it is well to remember that herpes 
is at first announced by an eruption of accuminate vesicles, 
and the subsequent ulcers are covered with a serous exudate. 
On the other hand, mucous patches are flat, and are covered 
with macerated epithelium. 

The herpetic eruption consists of a vesicle or group of 
vesicles altogether different from the eruption of syphilis. 
Herpes is marked by little inflammation, slight discharge, rarely 
bj T transitory enlargement of the neighboring glands, and does 
not present a history and course such as we observe in syphilis. 

In urethral syphilides, the spirochete pallida is present, 
and the Wassermann reaction may be obtained. These are 
absent in urethral herpes. 

There may be the history or evidence of the primary sore, 
in urethral syphilides. Absent in herpes. 



Diagnosis op Syphilis. 203 



Urethral Gumma — Tuberculosis — Cancer. 

These will receive further consideration when discussing 
the third stage of syphilis of the penis. 

Tuberculosis of the urethra has been produced experiment- 
ally in animals by injecting tubercle bacilli into the uninjured 
urethra of rabbits (Baumgarten) and guinea pigs (Cornet). 
A number of cases have been reported in which the urethra 
was apparently primarily affected by tuberculosis in both 
men and women. In searching the literature upon this sub- 
ject, it is well to bear in mind the fact that many writers 
report tubercles as primary infections, when they are the 
first extra-pulmonary lesions observed. Undoubtedly most of 
the cases may be attributed to infection with tuberculous 
sputum carried by soiled fingers. The infection may be car- 
ried directly to the urethra by instruments, catheters, bougies, 
sounds, coitus or masturbation. More rarely the infection pos- 
sibly comes from above, from a preceding tuberculosis of the 
kidney, bladder or prostate. The infection by the tubercle 
bacilli seems to be favored by gonorrhoea, stricture, phimosis, 
nephritis, trauma, and possibly also by alcoholism. Tuber- 
culosis of the urethra has been reported less frequently in 
women than in men. In the female, pregnancy seems to favor 
the infection. 

So that the diagnosis of tuberculosis of the urethra would 
be aided by finding tuberculosis of the lungs, tubercle bacilli 
in the sputum, or a tuberculous lesion higher up in the urinary 
tract; and the diagnosis would be made plainer by finding 
tubercle bacilli in the urethral secretion, or by a local reaction 
following the test injection of tuberculin. The endoscopic ap- 
pearance will often suffice to make the diagnosis, or a positive 
diagnosis could be made by finding the tubercle bacillus in 
scrapings from the affected tissue. 

Both cancer and tuberculosis do not necessarily give the 
history of syphilis, though they may occur in syphilitics. Both 
these affections are much more painful than gummata. Cancer 



204 Diagnosis op Syphilis. 

is especially prone to lead to adenopathies in the neighboring 
lymphatic glands. 

In early cases the diagnosis of cancer of the urethra may 
be facilitated by endoscopic examination, and the diagnosis 
may be made absolute by the microscopic examination of a 
portion of the growth. Later the nature of the disease will be 
declared emphatically by the course of the affection. Neither 
cancer nor tuberculosis are materially benefited by anti-syphil- 
itic treatment. Finally, cancer of the urethra usually begins 
at the meatus, or is secondary to cancer of the penis or of 
the vulva. 

The spirochete pallida speaks positively for syphilis. A 
spirochete may be present in cancer, but it differs in appear- 
ance from the spirochete pallida. The Wassermann reaction is 
of even more practical value at this stage of syphilis, because 
of the difficulty experienced in finding the spirochete pallida 
in the third stage of the disease. 



Diagnosis of Syphilis. 205 

MALE GENERATIVE ORGANS. 
Penis. 

The most frequent syphilitic lesion of the penis is the 
chancre, which has received sufficient description. 

The second stage of syphilis is often early represented upon 
the penis by the roseola and papular syphilides. 

The third stage of the disease also seems to show a predilec- 
tion for the penis, the gummata sometimes developing upon the 
scar of the initial lesion. In such cases the physician may be 
somewhat confused at times, since the lymphatic glands may 
still be enlarged. Frequently it is necessary to differentiate 
between gummata and papular syphilides of the penis. The 
ulcers may be formed by the breaking down of syphilitic 
pustules or gummata, and must in either case be differentiated 
from chancroid ulcers. Tubercular ulcers are comparatively 
rare, but must receive consideration in diagnosis. Cancer, espe- 
cially carcinoma, must be differentiated from gumma. Finally, 
it must be remembered that not all nodules in the penis are 
syphilitic. 

In making a diagnosis of syphilis, the history of the case, 
which is often misleading, is sometimes of value. The course 
of the disease and the presence or history of other syphilitic 
manifestations may shed valuable side lights. Most illuminating 
are the spirochete pallida and the Wassermann reaction, which 
may render clear the most obscure case. 

Penis. 

Syphilis : 

1. Chancre. 5. Chancroid. 

2. Roseola. 6. Tubercle. 

3. Papular syphilides. 7. Cancer. 

4. Gumma. 8. Simple tumors. 



206 Diagnosis of Syphilis. 

In making these differentiations, the spirochete pallida and 
the Wassermann reaction speak for syphilis, but do not exclude 
other affections. Mixed infection is not uncommon. 

The first stage of syphilis is frequently found upon the 
penis. Some authorities state that this is the most common 
syphilitic lesion of the penis. Next in frequency, if not as 
common, is the manifestation of the second stage. The gen- 
eral eruption of syphilis frequently involves the skin of the 
penis, including the thin skin covering the glans and the inner 
layer of the prepuce. During this stage the urethral mucous 
membrane may show various eruptions. These have received 
sufficient description under the discussion of the syphilitic affec- 
tions of the skin and mucous membranes. The third stage, 
marked by gummata, is less frequently found in the penis, but 
is far from infrequent. From these considerations, it is not 
strange that the penis is frequently the site of syphilitic scars. 

Chancre. The initial lesion upon the penis involves most 
frequently the prepuce, glans, or urethra. (See page 38.) 
Indolent buboes may be present in the groin at the time of 
the appearance of the primary sore, and usually are present 
within two weeks after the beginning of the chancre. The 
spirochete pallida may be readily found in the secretion from 
the chancre, and also in the serum aspirated from the buboes. 
The Wassermann reaction is not present before the sixth week 
after infection. 

The syphilitic lesions may encroach upon the lumen of 
the urethra, causing more or less occlusion. This usually 
disappears later, in the case of chancre. Gummata and the 
pustular syphilides may destroy tissue, and the cicatericial tis- 
sue that is formed, may contract and cause a stricture that 
is more permanent. 



Diagnosis of Syphilis. 



207 



Subpreputial Ulceration in Cases of Phimosis. 



Chancre. 

1. Incubation ten to forty days, 
usually two to three weeks. 

2. The ulcers are usually single. 
May be felt. 

3. Comparatively slight inflam- 
mation. 

4. The swelling is hard, dry, 
and indurated. 

5. Scanty discharge, serous or 
sero-sanguinolent ; may become 
purulent as the result of secondary 
infection. 

6. There is no marked inflam- 
mation and ulceration of the pre- 
putial orifice, save such as may be 
caused by secondary infection. 

7. Palpation may reveal the 
cartilaginous induration at the 
base of the ulcer. 

8. Multiple indolent buboes are 
the rule. Suppuration of buboes in 
eases of chancre is usually due to 
mixed infection. 

9. Spirochete pallida and Was- 
sermann reaction. The latter is 
not present before the sixth week. 



Non-syphilitic Ulceration. 
(Chancroid, herpetic, balanitic. ) 

1. Incubation less than a week, 
as a rule to be measured by hours, 
rarely more than two days. 

2. Multiple ulcers are the rule. 
At times these can be felt. 

3. Marked inflammatory reac- 
tion-heat, pain, redness and swell- 
ing. 

4. The swelling is more edema- 
tous in character. 

5. Profuse discharge, purulent, 
rarely streaked with blood, and in- 
fectious. Autoinoculation is com- 
mon, especially in chancroid. 

6. The margins of the preputial 
orifice are usually ulcerated, espe- 
cially in chancroid. 

7. There is no such induration, 
save such as may be caused by in- 
flammation, irritation, or caustics, 
or by a previous chancre. 

8. Buboes are usually absent, and 
when present are single or double, 
rather than multiple, and tend to 
suppurate. 

9. Spirochete pallida and Was- 
sermann reaction absent, except in 
the presence of a concomitant 
syphilis. 



Roseola and papular syphilides are the two most common 
eruptions upon the penis during the second stage of syphilis. 
(See pages 48, 54, and 58.) The eruption upon the penis 
is but a part of the general eruption, and has already been 
described in studying syphilitic affections of the skin. 

Gumma is not so frequently found as the secondary lesions, 
but is not rare. (See page 52.) 



208 Diagnosis of Syphilis. 



Chancre of Penis. 

Incubation : About two weeks, with limits extending from 
one week to two months. 

Confrontation : Derived from a preceding case of syph- 
ilis, directly or indirectly. Often attempts to deceive. 

Auto-inoculation does not occur; may infect others. 

Occurs at point of inoculation ; may be genital or extra- 
genital. 

Begins as an indurated infiltration or nodule. 

Shape: Usually round or oval. 

Location : Usually superficial. 

Cartilaginous induration of base. 

May be elevated; margins usually not markedly abrupt. 

Usually single ; multiple chancres are rare. 

Secretion : Scanty and serous. 

Pain and discomfort comparatively slight. 

Adenopathy : Indolent buboes usually appear within two 
weeks after the appearance of the chancre. 

Duration : A few weeks under anti-syphilitic treatment. 

Later appearance of second and third stages of syphilis, 
when not cured. 

Undergoes resolution, leaving a scar or loss of pigment 
when located on the skin ; these may not be visible when located 
upon mucous membrane. 

Spirochete pallida present, best found in scrapings from 
the deeper part of the chancre. 

Wassermann reaction present ; may be obscured by anti- 
syphilitic treatment. 

Immunity : Second attacks are rare. 

General health may be good. 



Diagnosis of Syphilis. 209 



Chancroid of Penis. 

Incubation : A number of hours ; usually the symptoms 
come on within a day or two after exposure. 

Confrontation : Due to inoculation from chancroid ( pus 
from ulcer of bubo). Often co-exists with syphilis. 

Auto-inoculation common; infects others to produce chan- 
croid. 

Usually confined to genitals ; extragenital chancroid is rare. 

Begins as a nodule and forms a pustule that breaks down 
to form a deep, painful ulcer with an unclean base. 

Induration may be caused by caustics or inflammation, but 
differs from the cartilaginous induration of chancre. 

Shape: Usually less symmetrical in outline than chancre. 

Edges clean cut, irregular, sometimes undermined. 

May be single ; often are multiple. 

Secretion: Abundant and purulent. 

Pain and discomfort greater than in chancre. 

Adenopathies in about one-third of cases. The buboes 
usually suppurate, and the pus from them is infections — may 
cause chancroid. 

Disappears promptly under local treatment ; not influenced 
by anti-syphilitic treatment. 

Chancroid is not followed by general symptoms. 

The local lesion is marked by greater persistence and more 
destruction of the tissue, when not treated, than occurs in 
chancre. 

Spirochete pallida absent. 

Wassermann reaction absent, except in syphilitics. 

No immunity; second attacks common. 

General health may be good. 



210 Diagnosis of Syphilis. 



Epithelioma of Penis. 

Usually requires months to develop, but may develop 
rapidly. 

Frequently history of exposure to cancer, or family history 
of cancer. 

Offensive odor; less marked under treatment. 

Occurs most frequently after forty. 

Impairment of general health occurs sooner than in syphilis. 

Pain is usually a prominent symptom. 

Shape : Irregular. 

Bleeds more readily than chancre. 

Absence of the cartilaginous induration of the base ; the 
base is less circumscribed and more extensive. 

Adenopathies : Enlargement of the lymphatics usually does 
not begin until after the first three months. 

Mercury is deleterious rather than beneficial. 

Microscopic examination: Endocytes, ingrowing epithelial 
cells, cancer nests. 

Spirochete pallida absent. A spirochete may be present, 
but it is not the spirochete pallida. 

Wassermann reaction: Absent, except in syphilitics. 

Usually induration is greater after ulceration. 

Cachexia comes on comparatively early. 

Absence of the history and evidence (lesions or relics) of 
syphilis. A syphilitic patient is not exempt from epithelioma, 
but the co-existence of the diseases is far from the rule. 



Diagnosis of Syphilis. 211 

Tubercular Ulcer of Penis. 

Slow in development. 

In the reported cases there has often been a history of 
unclean circumcision. Later in life the patients often have 
pulmonary tuberculosis, or there is a history of conjugal 
tuberculosis. 

The ulcers are usually multiple ; may be single. 

Most frequent under forty; often occurs in youth. 

Habitus phthisicus may be present in advanced tuberculosis. 

The ulcer is painful. 

Shape: Usually round, rather than ovoid. 

Absence of cartilaginous induration of the base. 

Usually small in size compared with the syphilitic lesions. 

Adenopathies: Usually absent; may be caused by secondary 
septic infection. 

Anti-syphilitic treatment valueless. 

Microscopic examination: Tubercle. 

Tubercle bacillus is present, but may be difficult to find 
in the tissue. 

Tuberculin test positive. 

Little or no induration. 

Cachexia is usually absent; may be present in cases of ad- 
vanced tuberculosis.* 



*Tuberculosis of the penis has been observed in a large number of 
cases. In almost every ease the infection has been ascribed to unclean 
circumcision. Such cases have been reported by Lindemann, Lehmann, 
Elsenberg, Hofmokl, v. Bergmann, W. Mayer, Eve, Loewenstein, Kolizow, 
Gescheit, Pasternatzki, Chwolsow, Janowitsch, Tschainski. 

Occasionally cases occur that may not be attributed to circumcision. 
Such cases are due in a great majority of cases, to infection carried by 
the fingers. It is remarkable that extra-pulmonary infection is not more 
common in cases of pulmonary tuberculosis. Occasionally tuberculosis 
of the penis occurs in patients that are not affected with pulmonary tuber- 
culosis. Cornil refers to a case described by Ssalitscheff, in which a 
primary tuberculosis of the glans penis was observed in a man of forty- 
seven, whose wife was apparently tubercular. 

In tuberculosis of the penis, the infection is derived from the sputum. 
This holds true in eases ascribed to unclean circumcision, in which it has 
been demonstrated that the infection came from oral haemostasis per- 
formed by a tubercular operator. The cases ascribed to coitus with a 
tubercular patient, are more likely cases of sputum infection. The tubercle 
bacilli may be conveyed from the sputum by unclean fingers, masturbation, 
or by contamination of the genitals with saliva. 



Ill 



212 Diagnosis of Syphilis. 



Ulcer of Penis Due to Pustules. 

Syphilitic pustules occur during the second stage of the 
disease. Cause rapid destruction of tissue. 

History or evidence of preceding chancre. 

Preceding pustular syphilide. 

Syphilitic pustules occur as large and small pustules. The 
small pustules, which may be miliary (about the size of a pin- 
head), are arranged in groups. Resemble lichen scrofulosorum. 
The large pustules are found early in the second stage of 
syphilis, often in association with papules. They run a pro- 
tracted course and differ from the eruption of smallpox in 
the absence of the vesicular stage. In the eruption that occurs 
later in syphilis, the pustules are circumscribed and are grouped 
like the papular eruption. 

The syphilitic pustules occur without previous vesiculation. 

After ulceration, the margin is infiltrated and sharply 
defined. 

Complicating inflammation may cause chronic edema and 
elephantiasic hypertrophy. 

The spirochete pallida is present, and the Wassermann 
reaction may be obtained. 

Other secondary lesions are usually present, especialy 
eruptions upon the skin and mucous membranes. 



Diagnosis of Syphilis. 213 

Gumma of the Penis. 

Usually occurs before forty. 

History or evidence of the preceding stages of syphilis. 

Gummatous ulcer : Does not bleed so readily as epithelioma ; 
the secretion is comparatively slight and not so offensive nor 
irritating as that of epithelioma. 

Induration precedes ulceration. 

Pain : Comparatively slight or absent. 

Cachexia is usually absent. 

Adenopathy: Comparatively slight; due especially to mixed 
septic infection. 

Microscopic examination: Granulation tissue. The spi- 
rochete pallida is difficult to find. 

Wassermann reaction, except when obscured by energetic 
anti-syphilitic treatment. 

Papular Syphilide of the Penis. 

The large papules are the only ones that need be con- 
sidered in this connection. 

Firm, sharply denned, brownish red papules. 

The size of a lentil or larger. 

Project somewhat above the surface. 

Enlarge from the center towards the periphery. 

After the formation of scales and crusts they disappear, 
leaving a slightly pigmented depression that later becomes 
white and shining. 

Usually there are present all stages of development and 
involution of the eruption, to aid in diagnosis. 

Often occurs as the first eruption during the second stage 
of syphilis, frequently associated with roseola. 

Constitutes the most frequent form of relapse of syphilis 
during the first decade. 

Central atrophy is a prominent diagnostic feature. 

Large papules, with central atrophy and peripheral growth, 
may attain the size of a dollar — syphilis papulesa orbicularis. 



I 



214 Diagnosis of Syphilis. 



Tumors of the Penis. 

Circumscribed fibrosis in the corpora cavernosa is so com- 
mon after forty as to merit a place among the natural changes 
in the body. Fibromata and enchondromata are not uncommon 
in this locality. Calcification is rare, and ossification is still 
more uncommon, only five cases having been reported. Soft 
warts are not uncommon on the glans or prepuce. Sometimes 
these become cornified, constituting the so-called horns. Epi- 
thelioma and sarcoma occur upon the penis, the involvement - 
being primary much more often than secondary. The most 
common malignant picture is that of a wart serving as the 
base of an epithelioma. 

Tumors of the penis may bear some resemblance to gum- 
mata, but there is an absence of the history and relics of 
the preceding stages of the disease, nor do we find gummata 
in other parts of the body. 

In non-syphilitic tumors, the spirochete pallida and the 
Wassermann reaction are lacking. The latter is of most prac- 
tical value in differential diagnosis in these cases. 

Cases of doubt may be decided by the therapeutic test or 
the removal of a section for microscopic examination, the 
method preferred usually depending upon the urgency of 
the case. 



Diagnosis of Syphilis. 215 



TESTICLES. 

The second and third stages of syphilis affect the testicles 
much more frequently than the penis, which is so frequently 
the seat of the primary sore. Syphilis may cause a simple 
orchitis, which is due to the development of smaller nodules 
that later cause sclerosis and atrophy (Malassez and Reclus). 
This is the orchitis syphilitica simplex of Virchow. The same 
investigators claim that the orchitis gummosa of Virchow is 
due to necrosis of the gumma and the sclerosed part. The 
orchitis may extend to the albuginea, to constitute a peri- 
orchitis, the albuginitis syphilitica of Ricord. 

A simple orchitis may occur early, within a few months 
after the primary inoculation. In such cases the epididymis 
is swollen, usually uneven, and, as a rule, painless. 

A simple orchitis, probably due to small gummata, is one 
of the prominent symptoms of the third stage of syphilis. 
This is the period when we may find the orchitis gummosa of 
Virchow. In tertiary orchitis the swelling of the testicle comes 
on slowly, with a feeling of dullness and weight in the scrotum, 
rarely with real pain. Digital examination will often reveal 
distinct nodules and depressions. Later the gummata disappear 
largely through absorption and contraction of the deposited 
cicatricial tissue, rarely with suppuration. Gradually the tes- 
ticles decrease in size, to show absolute atrophy in the course 
of a number of months. There may be but a rudiment of the 
testicle left. The epididymis is rarely primarily affected, and 
it usually does not show so great alterations, though it may 
present thickenings and cicatricial contractions. 

Sometimes confusion in diagnosis may be caused by the 
comparatively rare cases of fungus testiculi syphiliticus. These 
are cases in which a large gummatous mass of the testicle in- 
volves all the coverings of the testicle and perforates these, 
to appear as a soft, necrotic, fungus-like, granular mass, that 
discharges pus and necrotic tissue. Such cases are compara- 
tively rare. At first there is pain, which later decreases and 



216 Diagnosis of Syphilis. 

may disappear. Necrosis in time leads to greater or less de- 
struction of the growth and testicle. All this takes weeks or 
months, and is accompanied by more or less marked septic 
symptoms. 

Syphilitic orchitis is to be differentiated especially from 
traumatic orchitis, gonorrhoeal orchitis, epidemic orchitis, and 
tuberculosis and cancer of the testicle. 

Gonorrhoea affects especially the epididymis ; syphilis more 
frequently and most markedly affects the testicle. In lues the 
onset of orchitis is more gradual, the testicle is usually less 
tender, and the swelling is usually not so marked as in gonor- 
rhoea epididymitis. The syphilitic induration is usually found 
in the head of the epididymis. 

Epidemic orchitis may occur in the course of mumps. It 
is rare after thirty. The diagnosis is made by the affection 
of the parotid gland, parotitis epidemica ; the intense early 
symptoms, high fever and acute course ; the short course, 
usually but a few days ; and the exemption of the epididymis. 

Traumatic orchitis is marked by an acute inflammation 
following trauma. There is usually a history of the trauma- 
tism, which may, however, serve to localize an infection, such 
as tuberculosis. There is a more acute course, marked by pain, 
swelling, fever, and possibly abscess formation. 

Tuberculosis of the testicle runs a chronic course, like 
syphilis, but shows as a rule a distinct preference for the epi- 
didymis. Fistula? are more common in tuberculosis than in 
syphilis of the testicle. Ulceration and breaking down of the 
nodules is much more common in tuberculosis, which also much 
more frequently extends to the vas deferens, seminal vesicles 
and the prostate. In tuberculosis of the testicle there is almost 
always pulmonary tuberculosis. Tubercle bacilli may be found 
in the discharge. The tuberculin test will give a general 
reaction, and frequently also a local reaction. Furthermore, 
tuberculosis of the testicle does not show the same response to 
the therapeutic for syphilis as is found in syphilitic orchitis, 
especially early in the course of the disease. 

Carcinoma of the testicle does not undergo the same con- 



X 



Diagnosis of Syphilis. 217 

traction as is evidenced by the atrophy following syphilis. 
Cancer shows more of a tendency to grow towards the surface 
and break down, forming a fungous ulcer, fungus testiculi 
malignus. Cancer frequently originates in the testicle, but pro- 
duces a more continuous and progressive affection of the 
lymphatic glands. 

1. Syphilitic orchitis. 4. Epidemic orchitis (mumps). 

2. Traumatic orchitis. 5. Tuberculosis. 

3. Gonorrhceal orchitis. 6. Cancer. 

A careful search may disclose the spirochete pallida in the 
blood. Of more practical value is the Wassermann test, which 
is present in syphilis, though it may be observed or rendered 
negative by anti-syphilitic treatment. 

The spirochete pallida and the Wassermann reaction indi- 
cate the presence of syphilis, but not necessarily that the 
orchitis is syphilitic. Syphilitic patients are affected with non- 
syphilitic orchitis more frequently than with syphilitic orchitis. 



218 Diagnosis of Syphilis. 



Syphilitic Epididymitis and Orchitis. 

Syphilis, inherited or acquired, presents a history or other 
symptoms of the disease. 

During the second stage of syphilis, there may be a slight 
painless enlargement of the epididymitis. 

In the third stage of syphilis, the testicle shows a painless 
enlargement, when affected, being nodular when the disease is 
manifested by circumscribed gummata, and remaining smooth 
when there is a diffuse infiltration. 

Begins in the connective tissue of the testicle. 

The cord usually remains free from affection, and the 
seminal vesicles are uninfluenced by the disease. 

The process tends to run a chronic course. Tendency to 
fibrous overgrowth. Suppuration rare. Fistulae uncommon. 

Enlargement of testicle moderate, rarely more than twice 
the normal diameter. 

The opposite testicle remains free, and the prostate is not 
affected. 

Not much pain ; rather a feeling of weight. 

Potency is somewhat impaired. Atrophy of the testicle 
is common. 

Skin of scrotum often purplish, but is seldom involved. 

There is nearly always hydrocele. Abscess is rare. The 
urine remains clear. 

Wassermann reaction present. 

Little or no tenderness on pressure, and absence of dis- 
charge or bleeding, and fungous appearance rare. 

Curable, though chronic, and responds to anti-syphilitic 
treatment. 

Inguinal glands usually not involved. 



Diagnosis op Syphilis. 219 



Gonorrhoea! Epididymitis and Orchitis. 

History: Occurs in the course of gonorrhoea, usually in the 
second or third week, frequently late in the disease, sometimes 
after the patient believes himself to be free from infection. 
Affection of the testicle is favored by stricture, hypertrophied 
prostate, sexual or alcoholic excess, over-exertion, and instru- 
mentation. 

Most frequently occurs in gonorrhoea of the prostatic por- 
tion of the urethra. 

The onset is acute, as a rule, and recurrent attacks are far 
from uncommon. 

Involvement of the opposite testicle not uncommon. Po- 
tency is unimpaired, save in double orchitis. 

The posterior urethra is usually congested or inflamed. 
The testicle is sensitive. 

Hydrocele and abscess are rare. The urine is cloudy. 

Shows a preference for the left testicle. 

Usually the epididymis is the part affected, causing tender- 
ness upon palpation posterior and external to the body of 
the testicle. Exceptionally the epididymis may be anterior or 
internal or superior to the testicle, or in some abnormal relation 
to the body of the testicle. The involvement of the unde- 
cended testicle may vary the picture. 



220 Diagnosis of Syphilis. 



Tubercular Epididymitis and Orchitis. 

Prefers youth; has been found in the fetus. 

History : Association with tuberculous patients ; the patient 
may suffer from pulmonary tuberculosis, or there may be a 
family history of the disease. Conjugal tuberculosis. 

A preference is shown for the epididymis, which becomes 
nodular ; hard, irregular tumor, the substance of the testicle 
and the vesiculs seminales are less frequently involved. 

The tumor is of moderate size. 

The prostate is congested and may be tuberculous. Rectal 
examination reveals enlargement of the seminal vesicles. 

The affection runs a chronic course. The disease is marked 
by recurrent acute attacks. 

Potency is somewhat impaired. Atrophy of the testicle is 
rare. The testicle is sensitive. 

There is often hydrocele, and abscess is common. The 
urine is cloudy and may contain tubercle bacilli (which should 
be carefully differentiated from the smegma bacillus). 

Tuberculin test is positive. 

There is some pain. 

Development is slow. Often the cases do not come under 
observation for a number of months. 

The tuberculous nodule is harder than the malignant tumor 
of the testicle, and shows earlier tendency to become adherent 
to the skin. 

Frequently ends in ulceration and fistulae. 

Tendency to fatty, caseous or purulent degeneration. 

The skin is congested, but is involved only in the process 
of abscess formation. 

Often marked tenderness. 

Discharge is not especially offensive. 

Fungus appearance is common. 

Lasts for several years, and some cases are cured. 

Inguinal glands usually not involved. 



Diagnosis of Syphilis. 221 



Cancer of the Testicle. 

Carcinoma of the testicle is most frequent between thirty- 
five and forty ; sarcoma is observed most frequently in early 
life, up to ten years, and in adults between thirty and forty. 
Spindle-celled sarcoma nearly always occurs under ten ; the 
round-celled sarcoma is most frequent between thirty and forty. 

Adenopathies occur. Enlargement of the lymphatic glands 
is rare early in carcinoma — during the first three weeks. Sar- 
coma of the testicle shows involvement of the lymphatic glands, 
especially the retroperitoneal glands. The lymphatic involve- 
ment in this region seems an exception to the general rule in 
sarcoma. 

There is often a history of trauma preceding the affection 
of the testicle. 

The growth first appears, as a rule, in the region of the 
hilum, between the testicle and the epididymis. 

Growth is at first slow, so that often it is several weeks 
or even months before the patient comes under observation. 

Sarcoma presents a solid, smooth, symmetrical growth. 
Hydrocele is usually absent. The scrotal veins are dilated. 

Pain is usually, but not invariably, present. 

Malignant disease often shows a marked temporary response 
to the therapeutic test with the iodides. 

Wassermann reaction: Absent, except in syphilitics. 

In cases of doubt, the removal of a section for microscopic 
examination is justifiable. 



222 Diagnosis op Syphilis. 



Encephaloid Carcinoma of Testicle. 

There may be a family history of cancer, or the history of 
association with cancer cases. 

Encephaloid carcinoma begins in the testicle, affecting pri- 
marily the seminiferous tubules. The course is rapid. Tend- 
ency to disintegration of tissue in multiple patches. Ulceration 
and fungus appearance common. Fistula? common. There 
is severe lancinating pain, especially late. The tumor is soft, 
often fluctuating. The skin presents a network of large veins 
over the surface of the tumor, and is finally involved. The 
testicle is greatly enlarged. There is little or no tenderness on 
pressure. The discharge is offensive, and bleeding is inclined 
to be free. Fungus appearance is characteristic in advanced 
cases. A cure is rare ; most cases terminate fatally within two 
years. The inguinal glands are usually involved, and also the 
iliac and lumbar glands. 

Cancer does not present the history nor other evidences of 
existing or preeisting syphilitic lesions. 

The Wassermann reaction is negative. 

There may be some response to the energetic use of anti- 
syphilitic treatment, but the improvement is not so markd 
nor permanent as in syphilis. Usually it is unsafe to delay 
diagnosis, so that the therapeutic test for syphilis is of less 
practical value in these cases than the serum reaction. 



Diagnosis op Syphilis. 223 



Benign Tumors of the Testicle. 

The more common benign tumors are: fibromata, enchon- 
dromata, osteomata, and myomata. Lipomata and fibromata 
may occur in the tunica vaginalis, usually to be unrecognized 
during life, unless they become large, when they may resemble 
the malignant growths. Teratomata, bengin and malignant 
cysts may occur here. Among the malignant tumors, carci- 
nama especially the medullary form, is more common than 
sarcoma. 

Tumor may give the history of trauma. The testicle be- 
comes more or less enlarged, depending upon the size of the 
tumor, which may vary greatly. The cord is not affected ; the 
veins may become dilated. The seminal vesicles are not affected. 
Tumors are essentially chronic in their mode of onset, and 
run a fairly rapid course in this region. Potency is unim- 
paired. The urine remains clear. Hydrocele is unusual, and 
there is no tendency to the formation of abscess. Atrophy of 
the testicle does not occur, and the opposite testicle remains 
free from affection. 

Absence of the history or evidence of existing or pre- 
existing lesions of syphilis. 

Wassermann reaction absent. 

Therapeutic test for syphilis negative, though there may 
be some response to energetic anti-syphilitic medication. 



224 Diagnosis of Syphilis. 



Traumatic Orchitis. 

Caused by trauma: Blow, kick, missile, fall. 

Runs a course much similar to epididymitis. 

Traumatic orchitis, even though severe, is usually not fol- 
lowed by sterility. Atrophy of the testicle is more common 
than in gonorrhceal inflammation. 



Epidemic Orchitis (Mumps). 

Other sjmptoms of mumps, especially parotitis; history of 
exposure to mumps. Presence of an epidemic of mumps. 

Incubation : Often occurs during the course of mumps. 
The incubation of mumps is about two weeks, varying from 
three days to six weeks. During this period prodromal symp- 
toms are present in about one-third of cases. 

Mumps is announced by chill or chilly sensations. The 
fever is slight, 101° or less, reaching later in the course of the 
disease 102°, exceptionally 104°. Swelling of one or both 
parotid glands, accompanied by pain and tenderness, is one 
of the most characteristic features of the disease. 

Orchitis occurs in about two-thirds of the cases. 

Atrophy of the testicle results seven times out of ten. 

Double orchitis is comparatively rare; when it does occur, 
impotence may follow. 

Orchitis occurs in many of the infections : 

1. Typhoid fever. 4. Tonsilitis. 

2. Influenza. 5. Rheumatism and 

3. Smallpox. 6. Mumps. 



Diagnosis op Syphilis. 225 



The Semen. 

Syphilis of the testicle is prone to affect the secreting part, 
so that later there is diminution of the semen, sometimes abso- 
lute aspermia. 

The possibility of paternal transmission of syphilis is well 
recognized. It is not known whether this occurs through dis- 
ease of the spermatazoa or through the excretion of the syph- 
ilitic poison in the semen without affection of the living sper- 
matazoa. It is the writer's opinion that paternal transmission 
of syphilis can occur only through inoculation with infected 
hands or by semen from syphilis of the male generative organs, 
especially the testicle. The spirochete pallida has been ob- 
served in the semen of syphilitics. Unfortunately, syphilis of 
the male generative organs may not always be detected during 
life. Syphilitic impotence usually does not occur until late in 
the disease. 

Oligospermia, azoospermia or impotentia may result from 
gummatous orchitis, though great deformity and destruction 
of tissue may occur without rendering the patient impotent. 
The diffuse interstitial gumma, orchitis fibrosa syphilitica, may 
cause impotence through compression of the canals due to 
contraction of the connective tissue. 

As a rule impotence is not caused by syphilis. 



226 Diagnosis op Syphilis. 



SYPHILITIC AFFECTIONS OF THE FEMALE 
GENERATIVE ORGANS. 

Vulva. 

In women, the primary sore of syphilis is found most fre- 
quently upon the vulva. This fact should only emphasize the 
importance of differentiating between chancre and other lesions 
that may occur upon the vulva. The chief of these are simple 
ulcer, chancroid ulcer, cancer, and tuberculosis, both the tuber- 
cular ulcer and lupus. The spirochete pallida is present in 
chancre, and its recognition makes the diagnosis of syphilis 
absolute. The Wassirmann reaction is not present before the 
sixth week. 

During the second stage of syphilis, syphilides, especially 
mucous patches, frequently occur upon the vulva. The Was- 
sermann reaction is present, and the spirochete pallida may be 
found in the secretion from the patches. It is better to secure 
the specimen of serum from the deeper part of a patch, by 
scraping. 

The third stage of syphilis is rarely represented by gum- 
mata of the female genitalia. When gummata do occur in 
this region, they are most frequently located in the vulva. 

The tertiary lesions often appear in parts affected by 
the preceding stage of the disease, apparently developing from 
remnants of the secondarv lesions. 



Diagnosis of Syphilis. 



227 



Chancre of the Vulva. 



Confrontation. — Due to inocula- 
tion from a ease of syphilis. De- 
ception is common. Furthermore, 
because of false modesty and the 
comparatively slight discomfort 
these patients often experience, the 
physician is frequently not con- 
sulted until late, at which time 
other lesions are present. 

Incubation. — Usually two or three 
weeks, sometimes as short as a week' 
and possibly as long as two months. 

Location. — Most frequent on the 
labia majora (about one-third of 
cases) ; frequently situated at the 
introitus of the vagina, in the re- 
gion of the meatus, and the nym- 
phse; less frequently upon the four- 
ehette, the prepuce of the clitoris. 

Autoinoculation does not occur ; 
but multiple chancre is more fre- 
quent in this region than elsewhere. 

Begins as infiltrated induration or 
nodule, that usually has undergone 
central necrosis to form an ulcer be- 
fore the patient comes under obser- 
vation. 

Shape. — Symmetrical ; usually 
round or oval. 

Ulcer. — Usually superficial, may 
be elevated, rarely deep; sloping 
edges. 

Floor of View. — Smooth, red, 



livid, often covered with a scab or 
membrane. 

Secretion. — Scanty and serous, in 
the absence of irritation or second- 
ary infection — which is not uncom- 
mon in this region. 

Induration. — Cartilaginous. 

Sensibility. — Little or no pain, so 
that it often passes unnoticed. 

Course. — Regular; phagadena 
rare; confers marked immunity. 

Adenopathy. — Indolent buboes are 
the rule, though suppuration may 
occur, due to mixed infection. Usu- 
ally the glands are first found en- 
larged upon one side, then upon 
both sides, from one to four or more 
upon either side, in the region of 
Poupart's ligament. 

Termination. — Usually undergoes 
resolution, to be followed later by 
the general symptoms of syphilis, 
unless the disease is cured. 

Mercury is specific. 

Spirochete pallida. — Present. The 
recognition of this organism, en- 
ables the diagnosis to be made posi- 
tively much earlier than was for- 
merly possible — before the charac- 
teristic induration appears. 

Wassermann reaction. — Present 
later, after the body has had time 
to reaet against the syphilitic virus. 



228 



Diagnosis op Syphilis. 



Chancboid of the Vulva. 



Due to inoculation from chancroid 
(ulcer, bubo, or lymphitis). Ofter 
associated with the other venereal 
diseases. 

Incubation is short, a number of 
hours, so that the ulcer is present 
a day or two after exposure. 

The most frequent locations are 
the labia majora, especially the pos- 
terior commissure, the vaginal ori- 
fice, the fimbria 1 marking the re- 
mains of the hymen, the urethral 
orifice. More than one-third of the 
eases occur on the fourchette or 
fossa navicularis. Extra-genital 
chancroid is rare. 

Autoinoculation is common; mul- 
tiple ulcers are the rule. 

Begins as a nodule, that soon be- 
comes pustular and ulcerates. Usu- 
ally the ulcer is present when the 
patient is first seen, and the other 
stages of new lesions may be ob- 
served. 

Less symmetrical than chancre; 
the borders often describe segments 
of circles. 

Involves the whole thickness of 
the integument: sharp, abrupt edges, 
often undermined. 



The floor is rough, grayish, pul- 
taceous, covered with secretion. 

The secretion of the ulcer is 
abundant and purulent. 

Induration is absent, except when 
caused by caustics or inflammation, 
when it does not resemble the cir- 
cumscribed cartilaginous induration 
of chancre. 

Chancroid is painful. 

Runs an irregular course, with 
tendency to spread; phagedena com- 
mon; little or no immunity, so that 
second attacks are common. 

Affection of the lymphatic glands 
is not so common as in chancre. 
When present, the buboes are in- 
flammatory in character and usually 
suppurate. Pus from them is in- 
fectious. 

The local lesion is marked by 
greater persistence and more destruc- 
tion of tissue than is observed in 
chancre. Not followed by general 
symptoms. 

Local treatment is curative. 

Spirochete pallida absent, except 
in syphilis. 

Wassermann reaction indicates 
syphilis. 



Diagnosis of Syphilis. 



229 



Cancer of Vulva. 



Carcinoma and sarcoma are rarely 
primary in the vulva, usually ap- 
pearing secondary to lesions in the 
vagina or uterus. However, primary 
involvement of the vulva is a pos- 
sibility that must be remembered 
by the diagnostician. 

Carcinoma usually begins as 
small, round, irregular nodules, usu- 
ally located upon the inner surface 
of the labia majora or between the 
labia majora and minora. The nod- 
ules are covered with scaly epi- 
thelium, that soon disappears with 
ulceration. Before ulceration, the 
nodules cause little or no discom- 
fort, and they are usually of slow 
growth, so that they may give rise 
to no symptoms for some time, ex- 
cept possibly a slight pruritus. Of- 
ten they remain for some time un- 
noticed. Ulceration is followed by 
pain and a serous or bloody dis- 
charge, and further infiltration and 
hardening of the tissue. The mar- 
gins of the ulcers are irregular and 
raised, and the discharge becomes 
seropurulent and offensive. The 
process is usually unilateral. Ade- 
nopathy appears in the inguinal 
glands. The disease shows a ten- 
dency to develop more rapidly and 
involve the deeper tissues. Thus, 
there may be great destruction, in- 
volving the nymph*, clitoris and the 
vaginal walls. Pruritus is a prom- 
inent sypmtom; pain varies greatly 



in intensity in different case3. 

Sarcoma of the vulva is much 
more rare than carcinoma. The most 
common types of sarcoma in this re- 
gion are the melano-sareoma and 
myosarcoma Sarcoma prefers youth. 
The labia majora is the site of pref- 
erence, though sarcoma may begin 
in other parts of the vulva. The 
symptoms are not marked until ex- 
coriation or ulceration takes place. 

Epithelioma may resemble syph- 
ilis and lupus, at first, but the his- 
tory and symptoms soon make the 
diagnosis. In chancre, the inguinal 
glands are more quickly involved, 
and the constitutional symptoms 
soon appear. Chancroid shows 
marked ulceration with little or no 
induration, and edges that are more 
sharply cut and perpendicular. 
Lupus is marked by concomitant 
ulceration and cicatrization, and 
less pain than is present in carci- 
noma. The odor soon becomes more 
offensive in carcinoma than in syph- 
ilis or lupus. 

When the diagnosis is in doubt, 
especially if the spirochete pallida 
and the Wassermann reaction are 
not found, we should resort to the 
microscopic examination of a sec- 
tion of the affected tissue. The 
specimen should be taken so as to 
include both the diseased and the 
healthy tissue. 






230 



Diagnosis of Syphilis. 



Tuberculosis of Vulva. 



In the female genital tract, tu- 
berculosis seems to prefer the tubes. 
Primary tuberculosis of the vulva 
is very rare, but probably not so 
unique as the statistics would seem 
to indicate. Cases have been de- 
scribed by numerous observers — 
C'hiari, Cayla, Maedonald, Peckham 
and Lewers, Haberlin, Viatte. In 
this connection, it is well to take 
only the cases reported by com- 
petent observers, since the smegma 
bacillus may be mistaken for the 
tubercle bacillus by those not fa- 
milnr with the technique of stain- 
ing this organism. 

Tuberculosis of the vulva prefers 
the labia majora and the labia mi- 
nora. The lesion is sometimes found 
in the region of the anus. Usually 
the secretion of the ulcers and the 



tissues of the papules contain nu- 
merous tubercle bacilli, but some- 
times these can not be found. 'J he 
tubercular lesions appear as flat, 
assured, painful ulcerations, with 
irregular serrated borders. The 
color of the ulcer is pale red or 
grayish. There is a thin, purulent 
secretion. The ulcer tends to en- 
large at the periphery, while in the 
center a Hat cicatrix forms. Com- 
plete spontaneous recovery of the 
entire lesion is rare. 

Tuberculosis of the female geni- 
tals is more frequent than is gen- 
erally believed. In the examina- 
tion of women dying of phthisis, 
Kiwisch found genital tuberculosis 
in the proportion of 1.40; Cornil 
in 1.50-60 cases. 



Lupus of tiie Vulva. 



The recent lupus nodules are em- 
bedded in the true skin and do not 
disappear upon pressure. The lupus 
ulcers are marked by their indo- 
lence. There is little tenderness. 
The base and edges of the ulcer are 
flabby and vascular, and there is an 
abundant development of granula- 
tions. The tendency to spread from 
center to periphery is not so marked 
as in syphilis. The diagnosis is 
sometimes aided by the appearance 



of new lupus nodules in from two 
to four weeks. The course of lupus 
is slower than that of syphilis; 
lupus will often cause less destruc- 
tion in years than syphilis causes 
in a few weeks. Finally, lupus is 
due to the tubercle bacillus, and 
syphilis to the spirochete pallida. 
The tuberculin reaction speaks for 
lupus; the Wassermann reaction in- 
dicates syphilis. 



Diagnosis op Syphilis. 



231 



Condylomata of the Vulva. 



Venereal warts occur especially 
in the presence of uncleanliness, 
and are frequently found in syph- 
ilitic and gonorrheal cases. These 
are sometimes known as pointed 
condylomata. They present the 
general characteristics of warts, 
are provided with a pedicle, and 
vary in size from a pinhead to a 
pea. Because of their vascular 
structure, they have a tendency to 
bleed out of proportion to the size 
of the growth, when injured. 

Condyloma lata is of more in- 
terest to us, since it is a syphilitic 
lesion. The heat and moisture in 
this region favor the maceration of 
the papular syphilide, which be- 
comes denuded of its epithelial cov- 



ering, and also grows in circumfer- 
ence at the base. Thus, there is de- 
veloped a lesion varying in size 
from a pea to a quarter, or even 
larger, slightly elevated above the 
surrounding tissue, with abrupt 
margins and a broad flat surface. 
Condylomata lata are often found 
when the patients first come under 
observation, associated with remains 
of the chancre and various syphil- 
ides. 

Condyloma lata is very infectious. 

Causes little or no pain or dis- 
comfort. 

Responds to anti-syphilitic treat- 
ment. 

Spirochete pallida present. 

Wassermann reaction present. 



Elephantiasis of the Vulva. 



Elephantiasis arabum is rare in 
this country. The labia majors be- 
comes enormously swollen. The 
tissues are thickened and the lym- 
phatic vessels are dilated. Punc- 
ture or incision reveals a clear or 
milky fluid. The disease is due to 
the filaria sanguinis hominis. 

'Syphilitic elephantiasis of the 
vulva is much more common in this 
country. Both the labia majora and 
minora hecome enlarged, and may 



be covered with warty growths. 
Old cases often show ulceration, due 
to maceration and chafing. Usually 
both sides are affected, but not in- 
variably. 

The disease is marked by lymph 
stasis. 

Wassermann reaction is present. 

Therapeutic Test. — Anti-syphilitic 
medication is usually not sufficient 
to remove the hypertrophy; an ap- 
peal must often be made to surgery. 



232 Diagnosis of Syphilis. 

Vagina. 

The initial lesion of syphilis may occur in the vagina, but 
it is rare in this location. 

The papules and other syphilides have been observed in the 
vagina, but they seem to be comparatively rare in this part of 
the genital tract. Usually they occur in association with vul- 
var lesions. 

Gummata have been reported in the vagina, but are rare. 
Gummata of the rectum may affect the vagina and cause 
fistulae. 

Uterus. 

The first stage of syphilis is frequently announced by a 
chancre upon the cervix, most frequently upon the posterior 
lip. This is not so common a location of the primary sore 
as the vulva, but it is sufficiently common to warrant the 
physician being very careful in the examination of these cases. 
Fortunately, the hands may be protected by rubber gloves 
when called upon to make a digital examination in a suspicious 
case. It is a pretty good general rule to use the gloves unless 
there is a reasonable certainty that the case is not syphilitic. 

It seems probable that the semen may carry the syphilitic 
infection. If this is true, we must admit the possibility of a 
chancre in the body of the uterus or the tubes, though I know 
of no authentic case. The apparent rarity of such cases 
argues against the frequency of this mode of infection. 

The positive diagnosis of cervical chancre is made by 
finding the spirochete pallida. The differentiation from cancer 
may be settled, in case of doubt, by submitting a section to 
microscopic examination. Chancroid and tuberculosis must at 
times be considered. A simple ulcer or gonorrhoea may enter 
into the question of differential diagnosis. 

During the second stage, syphilides, especially papules, are 
found upon the cervix somewhat more frequently than in the 
lumen of the vagina. An endometritis may occur during this 



Diagnosis op Syphilis. 233 

stage, which some observers believe may be due to an eruption 
of syphiloderms upon the mucous membrance of the uterus. 
Gummata have occasionally been reported in the cervix. 
There are no authentic cases of gummata of the body of the 
uterus, in the literature examined by the writer. 

Fallopian Tubes. 

There are no cases of primary sore of the tubes reported. 
This fact would seem an argument against infection being car- 
ried to the mother by the semen. 

Catarrhal salpingitis may occur during the second stage of 
syphilis, which the writer believes may be due to tubal 
syphilides. 

Gummata have been observed in the tubes, in association 
with gummata of the liver and brain. 

Ovaries. 

The most important lesions occur during the third stage of 
syphilis. Gummatous oophoritis may or may not be diffuse. 
The disease may lead to the conversion of the ovaries into a 
cicatricial mass, without Graafian follicles. Such patients, of 
course, are sterile. Tumors in the region of the ovaries, have 
been observed to diminish or disappear under the therapeutic 
test for syphilis. 

The Wassermann reaction is positive, and there may be 
found the history and other evidences of syphilitic affections 
of other parts of the body. 



234 Diagnosis of Syphilis. 



SYPHILITIC AFFECTIONS OF THE ORGANS OF 
LOCOMOTION. 

Periosteum. 

Here we will consider only the second and third stages of 
syphilis. Two affections of the periosteum occur frequently in 
syphilis, namely, the simple periostitis and the gummatous 
periostitis. Simple periostitis may occur in other diseases than 
syphilis ; gummatous periostitis, on the other hand, occurs only 
in syphilis. 

Second Stage. — Simple periostitis may result in circum- 
scribed, less often diffuse, thickenings of the periosteum. The 
thickening is due to a growth beneath the periosteum and 
firmly adherent to it. Later the growth undergoes ossification 
and becomes intimately attached to the bone. This is the 
ossifying periostitis syphilitica, that causes (1) circumscribed 
deposits of bone, tophi, or (2) a diffuse thickening of the 
bone over larger surfaces. 

At first these deposits are not attached to the bone. Later, 
after they become intimately blended with the bone, there is 
usually more or less constriction at the base, indicating that 
the new formation did not originate from the bone. 

In diagnosis, it is often important to recognize the possi- 
bility of absorption of the growths caused by simple syphilitic 
periostitis. As a rule, the probability of absorption under 
treatment depends upon the degree of ossification. Before 
ossification, proper treatment may cause the growth to dis- 
appear entirely. The possibilit} 7 of the growth breaking down, 
undergoing purulent disintegration, is not great, save in tuber- 
culous patients, when trauma not infrequently leads to caries 
and necrosis. 

The Wassermann reaction is of value in determining the 
presence of syphilis. The test may be negative in quiescent 
cases, or where there has been energetic anti-syphilitic treatment. 



Diagnosis of Syphilis. 235 

The spirochete pallida may be detected in the blood, but the 
examination is difficult and tedious. 

In the more superficial bones, palpation may reveal a pain- 
ful swelling, usually flat and more or less diffuse, depending 
upon the extent of the region involved in the inflammation. 
Usually the general symptoms are not so marked as in the 
non-syphilitic inflammations of the periosteum, so that the 
patient may not be kept from his work even where there is 
extensive involvement of the periosteum. The periostitis in- 
volves especially the portion of the periosteum next the bone, 
but frequently the external surface of the periosteum is also 
inflamed, and at times the superficial inflammation is the more 
prominent. 

The cessation of the growth of the swelling with at the 
same time a decrease of the pain, in cases that have existed 
for a short time, usually indicates that absorption will take 
place. If the swelling does not decrease, but rather con- 
tinues to increase after the pain becomes less, ossification will 
probably result. Ossification of the nodules or diffuse swell- 
ings may be detected by palpation only after a number of 
weeks or months. Even after ossification, absorption some- 
times occurs. When the periostitis occurs near the insertion 
of muscles, the process of ossification may extend to the 
muscles, myositis ossificans. A similar ossification of the 
muscles may occur in diseases of the central nervous system, 
and after great exertion. It has been known to disappear 
after the use of iodide of potassium — both the ossification and 
the tendency to ossification of the muscles. 

Suppurative periostitis shows pain during the acute course 
of the inflammation. The part is painful and tender. The 
skin becomes edematous, reddened and possiblj' thinned. When 
the pus bursts through the periosteum, the pain decreases, to 
disappear later with the discharge of the pus through the skin. 
The introduction of a probe through the sinus thus formed, 
will reveal the presence of roughened bone. With proper 
drainage, the loosened periosteum again will become adherent 



236 Diagnosis of Syphilis. 

to the bone through granulation. When a portion of the 
periosteum has been entirely destroyed by the process, the 
overlying tissues and skin become united to the bone in a 
cicatrix, which may assume the form of a cicatricial band. 

Chronic suppurative periostitis does not run such an acute 
course, the pain is less, and frequently the pus does not find 
exit through a fistula, but collects to form an abscess. Under 
treatment, the so-called "cold" abscesses of syphilitic periostitis 
are more frequently absorbed than the "cold" abscesses of 
tuberculosis. 

Third Stage. — Gummatous periostitis also develops espe- 
cially upon the under side of the periosteum, but much more 
frequently causes erosion of the bone, the gummata frequently 
passing into the Haversian canals. Around the gumma there 
is more or less extensive sclerosis and hyperostosis. The gumma 
is usually more soft and elastic to the touch than the deposits 
of simple periostitis. 

Perforation of flat bones may be caused by the erosion 
above referred to, especially if periosteal gummata occur in 
corresponding places on both sides of the bone. This is the 
caries sicca of Virchow. 

Gummatous periostitis does not go on to ossification, but 
terminates in absorption or ulceration. Absorption is followed 
by more or less depression over the affected surface. Around 
this depression there remains for a long time the wall of bone 
caused by the hyperostosis around the gumma. Later this, 
also, may be absorbed. 

Ulceration following gummatous periostitis may lead to 
superficial caries and necrosis, or to the formation of more 
or less extensive fistula? leading from the carious or necrotic 
bone. After the affected bone is thrown off, the soft tissues 
become intimately attached to the osseous cicatrix. 

The nodules of gummatous periostitis, which are at first 
firm to the touch, later show fluctuation, as the gummata 
undergo softening and liquefaction. The overlying skin re- 
mains normal in color for a long time, and may show only 
slight discoloration in the cases that terminate in absorption, 



Diagnosis op Syphilis. 237 

which is the rule under proper treatment. When the gumma 
breaks down, the overlying skin becomes discolored and thinned 
and finally perforated, to give exit to the necrotic gummatous 
tissue. The gummatous mass breaks down first in the center, 
and the ulceration proceeds gradually towards the circum- 
ference of the gumma. So at first the nodule will not col- 
lapse, and later, with the destruction of the periphery of the 
growth, the nodule seems to disappear rapidly. Usually the 
gumma involves the bone to a greater or less extent, so that 
after the termination of the ulcerative process there is a de- 
pression, frequently surrounded by the ring formed by the 
sclerosing ostitis. Later this also may be absorbed. 

Bones. 

It is not always possible to differentiate between gummatous 
periostitis and gummatous ostitis, since so frequently the gum- 
mata affect both the periosteum and the bone. 

Second Stage. — Simple ostitis may be caused by syphilis as 
well as by a number of other affections. In simple syphilitic 
ostitis, the bone is usually thickened. Later, as a rule, the 
thickened portion of bone becomes absorbed, and the process 
of absorption may extend to the healthy bone. This form of 
ostitis, and more often syphilitic osteomyelitis, may terminate 
in caries and necrosis. 

Third Stage. — Gummata may occur either in the bony 
tissue or in the medullary cavity. Gummata, of course, are 
found only in syphilis. The part of the bone invaded by the 
gumma becomes osteoporotic, and surrounding this there is a 
zone of sclerosis. Such is the usual course when the gummata 
are small and undergo absorption, which is the rule in such 
cases. More especially in the larger gummata, absorption is 
more or less incomplete, and there remains more or less of the 
gumma, which undergoes caseation. Usually the sequestra 
from necrotic gummatous bone, are rougher and appear as if 
they had been channeled or eaten by the disease, whereas the 
necrotic bone from cases of simple ostitis is usually more 



238 Diagnosis of Syphilis. 

smooth. Gummatous infiltrations of the bone probably do not 
undergo ossification. 

Syphilitic cachexia may lead to fragilitas ossium, osteop- 
sathyrosis. This affection involves usually a large number of 
bones, especially the long bones, and is characterized by fra- 
gility of the bones. Occasionally the syphilitics show a pecul- 
iar thinning or perforation of the flat bones, especially the 
parietal bones, less often the occipital. 

The early diagnosis of syphilitic ostitis or osteomyelitis 
is often difficult. Usually the affection runs a slow course, 
with at first dull pains. The pains are described as being 
deep in the bones, and show nocturnal exacerbations. The 
general symptoms are not marked. There is little or no fever. 
As the inflammation slowly progresses, the pain gradually in- 
creases in severity. A sclerosing ostitis leads to a sensation of 
heaviness of the affected bone. There may be pressure symp- 
toms, when foramina, canals or cavities are encroached upon. 
Asorption may lead to osteoporosis or actual fragilitas ossium. 
A simple syphilitic ostitis rarely undergoes suppuration. 

Gummatous ostitis and osteomyelitis may show no symptoms 
and end in absorption. Usually there is pain. Palpation may 
reveal tender spots, and percussion of the affected bone may 
disclose the location of the diseased focus. Usually the pain is 
severe, especially at night, and, as a rule, the pain is dis- 
tinctly referred to the affected part. The gummata frequently 
extend to the periosteum and the surrounding tissue, forming 
a prominent tumor. When central, the gummata often cause 
thinning of the bone, so that palpation may reveal crepitation, 
or slight trauma may cause fracture. If the gumma under- 
goes absorption, the bone may be left osteoporotic, so that 
fracture readily occurs. Shortening or absolute destruction 
of the bone may result. 

Gummatous ostitis may terminate in necrosis. The separa- 
tion of the bone is accompanied by more or less pain, depend- 
ing upon the tension produced by the suppuration attending 
the process. There may be an accompanying erysipelas or 
inflammation of the deeper structures, especially when there 



Diagnosis op Syphilis. 239 

is not free exit for the pus. When there is an ample fistula 
leading to the surface, the free discharge of the pus is accom- 
panied by less general disturbance, and there is not so much 
danger of erysipelas or inflammation of the deeper structures. 
The pus has a foul odor and continues to escape until all of 
the dead bone has been removed. After the dead bone is en- 
tirely removed, the fistula may close permanently, often with 
the formation of a cicatrix that binds the soft parts to the 
bone. Necrosis of bone may lead to the absorption of small 
bones, the perforation of flat bones, and such mutilation of 
the long bones that fracture may readily occur. 

The Wassermann reaction will reveal syphilis, but does not 
necessarily indicate that the bone affection is syphilitic. It will 
often be found of great value in diagnosis. 

The literature contains reports of syphilis of almost every 
bone in the body, so that we are justified in believing that the 
disease may affect any bone. Dittrich observed a case of 
syphilitic necrosis of the hyoid. Here we will consider only 
the bones more commonly affected. 

The skull seems a favorite site for syphilis, especially the 
frontal bone, the parietal bones, and the bones of the nose 
and the hard palate. The occipital and temporal bones are 
not so often affected. When the syphilitic process extends 
deep in the bones of the skull, there may be symptoms of cere- 
bral compression. The prognosis in such cases is grave, but 
not necessarily fatal, since the process may undergo absorption, 
especially when the patient is under specific treatment for 
syphilis. When the process terminates in necrosis, the outlook 
is worse. Often there may be extensive gummatous affection 
of the bones of the skull without suggestive symptoms, as has 
been evidenced by finding these growths at autopsy in the 
absence of symptoms during life. But usually syphilis of the 
bones of the skull produces marked symptoms. The soft parts 
are frequently destroyed, to reveal the necrotic bone. The 
skull may be perforated. In such alarming cases, the prog- 
nosis is not necessarily fatal, for even large perforations may 
be closed. Great care must be exercised when tempted to 



240 Diagnosis of Syphilis. 

remove a large sequestrum, since nature sometimes seems to 
be able to do this operation more safely than the surgeon. The 
defects are usually filled with a cicatrix, that binds the me- 
ninges to the bone and soft parts. The formation of new bone 
is more rare. 

Syphilitic necrosis of the skull may lead to meningitis; and 
syphilitic tumors may cause brain pressure symptoms, paralysis, 
epilepsy, and mental disturbance. In all these cases the prog- 
nosis is grave. 

An infected necrosis, that causes meningitis, is best treated 
surgically. Pus here, as elsewhere, should be discharged. 

Syphilitic affection of the orbital bones is not very com- 
mon, but should always be thought of when called upon to 
make a diagnosis in a case presenting the symptoms of a 
tumor in this region. There is often an accompanying gum- 
matous infiltration of the periosteum and the cellular tissue. 
The more superficial tumors may be felt. The deeper tumors 
are recognized chiefly by the protrusion and rigidity of the 
eyeball. Pain varies in intensity, and is sometimes excessive. 
The infiltration may cause rigidity of the eyelid. The syph- 
ilitic process may extend to the eye itself. The danger of 
loss of the eye or meninigitis must be recognized. However, 
anti-syphilitic treatment is usually followed by good results, 
though the course is often protracted. 

Syphilis of the nose or pharynx may extend to involve the 
base of the skull. Of the facial bones, those of the nose and 
the upper jaw are most frequently affected. 

The spinal column. The cervical spine are most frequently 
affected. The symptoms vary with the extent and location of 
the disease. There may be only tenderness and limited motion, 
or there may be great deformity and pressure symptoms. 
Syphilis of the vertebral arches may affect the nerve roots, 
the meninges and the medulla ; affection of the transverse 
process may lead to erosion of the vertebral artery and hem- 
orrhage. Extensive cervical spondylitis that leads to the de- 
struction of large portions of the cervical vertebras, will cause a 
kyphosis in this region, the head being bent forward and often 
inclined toward one of the shoulders. 



Diagnosis op Syphilis. 241 

Syphilis frequently affects the long bones. Thes disease 
seems to show a preference for the bones of the leg and fore- 
arm, the clavicle and the ribs. It may be stated as a general 
rule that the diaphysis is more frequently affected than the 
epiphysis. However, the joint is not always exempt. 

The long bones are usually affected in one or more places, 
rather in their entirety. This fact, together with the observa- 
tion that the more exposed bones (frontal bone, parietal bone, 
bone of the nose and upper jaw, the bones of the fore- 
arm and leg, the clavicle and the ribs) are most frequently 
affected, would seem to indicate that trauma is an important 
factor in localizing the syphilitic process. There is a close 
analogy to tuberculosis, for it is a well known fact that trauma 
will predispose to the development of tubercle. This recalls 
the old experiment of injecting tubercle bacilli into an animal 
and then breaking the bones. The tubercle bacilli become 
localized at the point of fracture, to form tubercles. So in 
syphilis, the patient often attributes affection of the bone to 
some trauma. The value of anti-syphilitic treatment in many 
cases of fracture or wounds, probably depends upon the 
specific address to a syphilitic process that had become local- 
ized in the fracture or wound. 

Swelling or enlargement of the bone, and pain, that is 
usually worse at night or whenever the patient retires, are 
prominent symptoms of syphilis of the bones. However, there 
may be great swelling without pain, or pain without apparent 
enlargement of the bone. It should be remembered that non- 
syphilitic exudations may cause pain in the bones that may 
show distinct nocturnal exacerbations. 

Of the syphilitic affections of the small bones, dactylitis 
syphilitica deserves special attention. This affection may begin 
in the bone, periosteum, fascia, tendons or tendon sheaths. One 
or more fingers may be involved. The affected bone soon be- 
comes greatly swollen. Necrosis is frequent, the necrotic bone 
being cast off gradually through a sinus or sinuses, or thrown 
off as a sequestrum. In this way part or all of a phalanx may 
be destroyed. With the termination of the process, the finger 
is left shorter than normal, as a rule. Rarely there is an 



242 Diagnosis of Syphilis. 

excessive formation of new bone, so that the finger may 
actually be left longer than normal. 

Syphilitic dactylitis causes little or no pain and is not ac- 
companied by acute inflammatory symptoms. These two diag- 
nostic points usually suffice to differentiate the affection from 
paronychia, whitlow and gout. Rheumatoid arthritis begins in 
the joints, involves the tendon sheaths, causes early deformity 
of the fingers, is painful, and is associated with other symp- 
toms of the disease in lieu of the symptoms of syphilis. En- 
chondroma is a more chronic affection, forms hard, well-defined 
tumors, and does not give the history of syphilis. Tubercular 
dactylitis presents a different history, usually occurs in indi- 
viduals having pulmonary tuberculosis, responds to the tuber- 
culin test and not to the therapeutic test for syphilis. 

Chronic syphilis, like chronic heart and lung diseases, may 
lead to the formation of drumstick fingers, with the character- 
istic enlargement of the terminal phalanges. 

The toes may be affected like the fingers, though less fre- 
quently. Upon the sole of the foot, syphilis may produce an 
ulcer resembling the perforating ulcer of the foot, that is ac- 
companied by great destruction of the soft parts, and may lead 
to necrosis of the bones of the foot. 

In making a diagnosis, syphilis must at times be differ- 
entiated from trauma, tuberculosis, sarcoma, rickets, osteo- 
malacia, necrosis following mercurial ulceration, phosphorus 
necrosis, actinomycosis, and a number of rare affections, such 
as the necrosis sometimes observed about the time of puberty 
in workers with mother-of-pearl, and the necrosis disseminata 
of Blasius, that may occur from concussion. 

Bones. 



(a) Syphilis. 


(e) 


Rickets. 


1. Gummatous osteitis. 


(0 


Osteomalacia. 


2. Simple syphilitic osteitis. 


(g) 


Necrosis following 


3. Gummatous periostitis. 




mercurial ulceration 


(b) Trauma. 


(h) 


Phosphorus necrosis. 


(c) Tuberculosis. 


(i) 


Actinomycosis. 


(d) Sarcoma. 


(J) 


Other necroses. 



Diagnosis of Syphilis. 



243 



1. That observed about the time of puberty in workers 
with mother-of-pearl. 

2. Necrosis disseminata of Blasius, that may occur from 
concussion. 



Syphilis op Bone. 

1. History or evidence of syph- 
ilis in patient or parents. No age 
is exempt. 

2. The diaphyso-epiphyseal swell- 
ings of the long bones usually oc- 
cur at or soon after birth. Some- 
times unilateral. 

3. The affection of the bones is 
usually preceded or accompanied by 
snuffles, coryza, eruptions upon che 
skin and mucous membranes. There 
may be hoarseness, nocturnal peev- 
ishness and irritability, and the 
senile appearance. Cachexia is ab- 
sent or only moderate. Pain is often 
greater at night. 



4. Circumscribed tumors on fron- 
tal and parietal bones, rarely on the 
occiput. 

5. The ribs are not often affected, 
and then usually not coincident with 
the other bones. 

6. Closure of fontanelles usually 
not delayed. 

7. Resolution occurs without leav- 
ing deformity, save such as may be 
caused by destructive changes. 

8. Synovitis is often present, es- 
pecially in the elbow and knee. In 
general, syphilis tends to spare the 
articulations. 

9. There are often sinuses and 
abscesses. 

10. Anti-syphilitic treatment is 
useful. 

11. Irregular abnormal deposition 
of lime salts. There may be sep- 
aration of the epiphyses. 

12. Mortality high, especially 
when many bones are involved. 

13. Spirochete pallida and Was- 
sermann reaction. 



Rickets. 

1. There may or may not be a 
syphilitic history. Prefers child- 
hood. 

2. The osseous deformities of rick- 
ets usually appear later, rarely be- 
fore six months. Bilateral. 

3. The deformity of the bones is 
usually accompanied or preceded 
by gastro-intestinal disturbances, 
marked by anorexia, and diarrhoea 
or constipation; bronchial catarrh 
and cough; nocturnal restlessness; 
sweating often without apparent 
cause; pallor; general sensitiveness 
of the body, and at times spasm, 
especially laryngo-spasm. Marked 
cachexia. 

4. The cranial bones are thick- 
ened in spots, especially in the oc- 
cipital region. 

5. The affection of the ribs, the 
so-calley rickety rosary, is usually 
coincident with the affection of the 
other bones. 

6. The closure of the fontanelles 
is delayed. 

7. There is usually some deform- 
ity, due to bending of the affected 
bones and distortion of the joints. 

8. Synovitis is rare. 



9. Sinuses and abscesses are com- 
paratively rare in rickets. 

10. Phosphorus treatment is use- 
ful. 

11. Deposition of a soft non-calci- 
fied osteoid tissue. 

12. Mortality not so high, espe- 
cially under proper treatment. 

13. Spirochete pallida and Was- 
sermann reaction absent, except in 
concomitant syphilis. Syphilitics 
are apt to be rachitic. 



244 



Diagnosis op Syphilis. 



Tuberculosis of Bone. 

1. Presence of pulmonary tuber- 
culosis: history of exposure to tu- 
berculosis; family history of tuber- 
culosis. Frequently there is a his- 
tory of trauma. Prefers adolescence. 



1. Usually begins in the medulla 
and tends to cause destruction of 
bone, usually terminating in suppu- 
ration, possibly as the result of 
mixed infection. 



3. Frequently there is emaciation 
and the evidence of tuberculosis 
elsewhere, especially in the lungs - 
and glands. 

4. Probably no bone is exempt. 
In the order of frequency, the fol- 
lowing bones are most frequently 
attacked: vertebra', hip joint, small 
joints of hand and foot, knee, the 
long bones, ankle joint, tarsus, el- 
bow, shoulders, and wrist. The 
cranial bones are not often affected, 
if we except the mastoid. 

5. Does not present the rickety 

rosary. 

6. Closure of the fontanelles is 
visually not delayed. Usually occurs 
after closure. 

7. Deformity due to destruction 
of bone and suppuration. General 
symptoms of tuberculosis assume 
prominence. 

8. Frequently involves the articu- 
lations. 



9. Sinuses and abscesses are com- 
mon. 

10. General treatment of tubercu- 
losis beneficial. Anti-syphilitic treat- 
ment useless. 

11. Formation of tubercle. 

12. Mortality high. 

13. Tubercle bacillus. Tuberculin 

test. 



Sarcoma of Bone. 

1. Absence of the history or evi- 
dence of antecedent syphilis, except 
when the diseases co-exist. Fre- 
quently there is a history of trauma. 
No age is exempt; prefers the period 
from twenty to fifty. 

2. May be central or periosteal in 
origin, the latter being of the more 
malignant type. Causes absorption 
of the normal bony tissue. For this 
reason, though the bone is appa- 
rently enlarged, it readily suffers 
fracture. 

3. The patients often appear in 
perfect health early in sarcoma; 
later the health is greatly impaired. 

4. Possibly no bone is exempt. A 
distinct preference is shown for the 
long bones, especially the femur, 
tibia, humerus, fibula, ulna, radius, 
in the order of frequency. 



5. Rickety rosary absent. 

0. Closure of fontanelles not de- 
layed. Usually occurs after the fon- 
tanelles have closed. 

7. Enlargement and destruction 
of affected bones. In the later 
course of the disease, the general 
health is greatly impaired. 

8. The central sarcomata are 
more prone to involve the extremi- 
ties of the bone, affecting the joints. 

0. Less tendency to form sinuses 
and abscesses. 

10. Anti-syphilitic treatment is 
often followed by temporary im- 
provement that may tend to obscure 
the diagnosis. 

11. General symmetrical enlarge- 
ment, due to growth of sarcoma. 

12. Mortality high. 

13. Microscopic examination re- 
veals the characteristic appearance 
of sarcoma. 



Diagnosis op Syphilis. 



245 



Osteomalacia. 

1. Recurrent attacks in succeed- 
ing pregnancies. May be family his- 
tory of osteomalacia. Often history 
of traumatism. Occurs at a later 
age than rickets. 

2. The disease is general in char- 
acter, affecting a number of bones. 

3. The pain in pregnancy occurs 
especially in the latter part of gesta- 
tion. The general health, at first 
good, later becomes impaired. 

4. The bones of the pelvis, spine 
and thighs are most frequently af- 
fected. 

5. Rickety rosary usually absent. 

6. Occurs after closure of the fon- 
tanelles. 

7. Deformity due to softening of 
the bones. 



8. Sinovitis is rare. 

9. Sinuses and abscesses absent. 

10. Anti-syphilitic treatment use- 
less, as is also the treatment for 
rickets. 

11. Softening of the bones due to 
lessening of the lime salts. 

12. Improvement or arrest usually 
occurs under treatment. 

13. Softening of the bones due to 
lessening of the lime salts, depend- 
ant upon decreased alkalinity of the 
blood, apparently caused by an in- 
fection (usually genital) with acid 
intoxication. The blood contains 
myelocytes, and an increase of eosin- 
ophiles. 



Actinomycosis. 

1. Often history of exposure to 
the disease in animals. Occurs most 
frequently in those brought in close 
contact with animals. Most fre- 
quently found in adults. 

2. A local affection, affecting espe- 
cially the jaw bone. 

3. Actinomycosis is characterized 
by an insiduous onset and chronic 
course. 

4. The jaw bone is most fre- 
quently affected — lumpy jaw. The 
general health, previously good, be- 
comes greatly impaired. 

5. Does not resemble rickets. Ro- 
sary absent. 

6. Usually occurs long after clos- 
ure of the fontanelles. 

7. Deformity due to expansion and 
erosion of bone, the formation of 
granulation tissue, and the presence 
of abscesses and fistulas. 

8. Sinovitis absent. 

9. Sinuses and abscesses common. 

10. Anti-syphilitic treatment use- 
less. The affection remains local in 
character. 

11. Lumps or nodules form, due 
to the growth of the aetinomyees. 

12. Chronic course. Mortality 
high; much depends on the location 
of the process. 

13. The pus discharged is granu- 
lar, and contains the ray fungus, 
recognition of which makes the diag- 
nosis absolute. 



Syphilitic osteitis affects individuals in all grades of health ; 
usually begins in periosteum; tends to formation of new bone, 
or to necrosis ; suppuration is often absent ; does not tend to 
involve neighboring articulations ; frequently affects cranium ; 
characterized histologically by a rather large mass of granula- 
tion tissue ; usually can be arrested or cured by anti-syphilitic 
treatment. 

Tuberculous osteitis is usually accompanied by other symp- 
toms of tuberculosis ; begins in the medulla ; tends to disin- 
tegration of the affected tissue; termination in suppuration the 



246 Diagnosis of Syphilis. 

rule ; tends to involve neighboring articulations ; rarely in- 
volves the cranium ; characterized histologically by tubercle ; 
not affected markedly by anti-syphilitic treatment. 

Rickets may sometimes resemble the bone lesions of heredi- 
tary syphilis. Epiphyseal swellings that occur during the first 
six months of life are usually syphilitic. Syphilitic epiphyseal 
swelling may be unilateral ; the rachitic affection is symmetrical. 
The enlargement of the costo-chondral articulations, commonly 
known as the rosary of rickets, is absent in syphilis. Rickets 
thins the bones ; syphilis enlarges them, but does not produce 
the nodes characteristic of rickets. Rickets causes tardy closure 
of the f ontanelles ; syphilis may cause abnormal closure of the 
various cranial openings, through osteophyte growths. Syph- 
ilitic bone lesions are usually accompanied by other sj'mptoms 
of syphilis, and they respond to anti-syphilitic treatment ; 
rickets causes other symptoms than those on the part of the 
bones, is not markedly benefited by anti-syphilitic treatment, 
but responds readily to the treatment of rickets. 

Trauma, when severe enough to cause necrosis, will usually 
be prominent in the history of the case. Syphilis is the most 
common cause of necrosis of bone. A less frequent cause is 
tuberculosis, and typhoid fever is a rare factor in the causa- 
tion of necrosis of bone. These need but be mentioned. 

Often there is a history of trauma in cases of syphilis, tu- 
berculosis, and sarcoma. But the trauma is usually not the 
overshadowing element in these cases. Furthermore, simple 
trauma does not present the Wassermann reaction, except in 
syphilitics. 

Actinomycosis is found most frequently in the head (jaw, 
tongue), neck, air passages (lungs), alimentary tract (small 
intestine), and skin. Actinomycosis occurs in man through 
direct transmission from infected animals ; and from foreign 
bodies, especially cereal grains with sharp extremities, more 
rarely isinglass, splinters, etc., which are contaminated by the 
parasite. Infection may occur through carious teeth, and the 
spreading of infection from barber's utensils has been noted. 



Diagnosis of Syphilis. 247 

Joints. 

Syphilis shows a preference for the knee and elbow, though 
the disease has been reported to have attacked practically every 
joint in the body. Arthralgias are often observed early in the 
course of syphilis, when they should be regarded as belonging 
to the second or irritative stage of the disease. The later cases 
are usually due to gummata. In either case, the disease may 
be monarticular or polyarticular. The simple cases, belonging 
to the second stage of syphilis, frequently undergo involution 
in the course of a week or two. The gummatous cases usually 
are more chronic, though spontaneous involution may occur 
even in these cases. At any rate, we occasionally observe the 
spontaneous cure of chronic cases that have begun late in the 
course of syphilis. 

The symptoms vary in intensity and character, depending 
largely upon the severity and extent of the process. At first 
there may be only pain, observed upon extreme flexion or 
extension of a joint. Palpation may reveal tender points in 
the joint. There is usually more or less swelling of the joint. 
Frequently there is fever, and in some cases the temperature is 
high. The pain usually shows nocturnal exacerbations, and the 
fever observes morning remissions. In more severe cases the 
movement of the affected joint becomes impeded, and there may 
be produced more or less deformity of the joint. In all cases, 
anti-syphilitic treatment may result in an arrest or cure of the 
disease. The cases that occur early in the course of the dis- 
ease, especially those that belong to the second stage, give the 
best prognosis. The later cases, especially those due to gumma, 
are more chronic and more frequently leave a stiff, ankylosed 
or deformed joint. Especially in the cases accompanied by an 
ostitis or periostitis of the bones entering into the joint, with 
more or less destruction of the cartilage, capsule and ligaments 
of the joint, there may be left a loose joint. Such a joint, 
for instance, at the elbow or knee, is comparatively useless. In 
the cases in which ankylosis occurs, the union is usually not 
bony. 



248 Diagnosis of Syphilis. 

Differential diagnosis calls for the recognition of joint 
tuberculosis, the exclusion of trauma, and the separation from 
rheumatism. Indeed, these cases were formerly included among 
the rheumatisms. In the separation from trauma, it must be 
remembered that trauma may serve as an etiological factor in 
the localization of the syphilitic process in a joint. Trauma 
may also serve to localize a tuberculosis or a rheumatism in a 
joint or joints. The same is true in rickets and osteomalacia, 
which may involve the joints. The rheumatisms frequently 
show affections of the heart, which are not so common in 
syphilis of the joints. When the heart is affected, rheumatism 
shows a preference for the mitral valve, whereas syphilis is 
more often accompanied by affection of the aortic valve. The 
therapeutic tests are often of value. Rheumatism responds to 
the salicylates, syphilis to the preparations of iodine and mer- 
cury. However, syphilis of the joints is often benefited by the 
salicylates, and rheumatism, especially chronic rheumatism, is 
frequently best treated by the iodides. The fact can not be 
emphasized too strongly that not every case that responds to 
mercury or the iodides is syphilis. Tuberculosis responds to the 
tuberculin test, and usually causes more rapid destruction of 
the joint than syphilis. 

The spirochete pallida and the Wassermann reaction speak 
for syphilis. The serum reaction is of most practical value 
in these cases. It may be absent in cases that receive anti- 
syphilitic treatment. 

In the differentiation between the affection of the joints 
during the second and third stages of syphilis, aid in diag- 
nosis may be afforded by the occurrence of the former com- 
paratively early in the course of the disease, often as one of 
the early symptoms of the second stage, whereas the gum- 
matous cases usually occur late in the course of syphilis. The 
irritative cases are often accompanied by pain and fever, 
whereas the gummatous cases are comparatively free from these 
symptoms and usually show more swelling than is observed in 
the early cases. 

In making a prognosis, it must be remembered that anti- 



Diagnosis of Syphilis. 



249 



syphilitic treatment may cause the syphilitic process to dis- 
appear, but can not replace destroyed tissue or cicatrices. 
Villous hyperplasia of the synovial membrane, accompanied by 
grating and friction sound upon movement of the joint, usually 
does not undergo complete cure. 



Syphilis of Joints. 



Syphilis most frequently affects 
the knee and elbow, but no joint is 
exempt. The diagnosis is based 
upon other symptoms of syphilis. 

Disease of the joints in syphilis 
range in severity from arthralgias 
to arthritis; there may be a chronic 
hydrarthrosis, villous hyperplasia 
of the synovial membrane, and in- 
volvement of the cartilages of the 
joints. 

The syphilitic affection may be 
monarticular or polyarticular. 

The affection of the joints may 
appear in the second or third stages 
of syphilis. Thus, Lang saw a case 
of disease of the hip-joint during 
the second stage of syphilis, in the 
presence of a recent exanthem. 

If the swelling is localized, in a 
part of the capsule or ligaments 
of a joint, it is probably gumma- 
tous. 

Syphilitic polyarthritis rarely 
shows cardiac complications, thus 
differing markedly from rheuma- 
tism. 

Syphilis of the joints may show 
great pain and marked fever, but 
in general the subjective symptoms 
are less obtrusive than the objective 
symptoms. The patients are often 
well nourished. 

A history of trauma is not un- 
common. 

The spirochete pallida and the 
Wassermann reaction indicate syph- 
ilis. 

Antiluetic treatment is often of 
value as a therapeutic test; but de- 
structive changes in the joints may 



be irreparable. The salicylates act 
promptly in acute articular rheu- 
matism, but have little or no effect 
in syphilis. 

In secondary syphilis, both inher- 
ited and acquired there is a lia- 
bility to general periostitis, usually 
slight and transitory. Though the 
periostitis may be severe, it is usu- 
ally transitory. 

Early in the second stage of syph- 
ilis, the most common affection of 
the joints is a simple serous syno- 
vitis, which may later become a 
chronic hydrops. 

The third stage of syphilis may 
present a chronic serous synovitis, 
accompanied by a thickening of the 
joint capsule, contraction and fib- 
rous ankylosis. This may be due 
to perisynovial gummata, or to 
gummata of the bone with second- 
ary involvement of the joint. There 
may be more or less destruction of 
the cartilage. 

Hereditary syphilis is peculiarly 
liable to bone complications. 
Chronic serous synovitis is often 
present, appearing especially as a 
symmetrical swelling of the knees. 
There is considerable thickening, 
but effusion is comparatively slight. 
Osteochondritis is common in hered- 
itary syphilis. This may be present 
at the time of birth or come on 
later. The bone is thickened and 
tender in the region of the epi- 
physes. The epiphyses may become 
separated. There may be greater or 
less deformity of the joint, the de- 
formity being especially prominent 
in cases that show suppuration. 



250 



Diagnosis op Syphilis. 



TUBEBCULOSIS OF JOINTS. 

Joint tuberculosis and tubercu- 
losis of the bones is most common 
in childhood. Acute osteomyelitis 
or epiphysitis presents a more sud- 
den onset, pain is more prominent 
and permanent, and necrosis and 
suppuration are more rapid. 

Radiography is often of value in 
the recognition of joint or bone 
tuberculosis, use being made of the 
plates rather than of the prints 
(Kiliani). In this way tuberculous 
foci may be discovered that would 
otherwise remain obscure. Thus, 
we may be able to recognize tuber- 
culosis in the vertebra? before the 
symptoms become prominent, and 
the rice bodies in the knee may be 
recognized upon the radiographic 
plate. 

In joint and bone tuberculosis, 
the tuberculin test may clear up the 
diagnosis. 



Traumatic Affections of Joints. 

A history of trauma is often pres- 
ent in the history of syphilis of the 
joints, and is not uncommon in 
rheumatism and joint tuberculosis. 
The trauma in these affections is 
often comparatively slight, so that 
we will be led to suspect some other 
cause of the joint lesion. Trau- 
matic affections of the joints occur 
in all degrees of severity. There is 
a tendency toward the development 
of syphilitic lesions in the injured 
joint, in syphilis, just as there is a 
tendency to the development of 
rheumatic affection of such a joint 
in the presence of rheumatism, or 
of tuberculosis in tuberculous pa- 
tients. The Wassermann reaction 
and concomitant symptoms of syph- 
ilis or the relics or history of the 
disease, may aid in diagnosis. 



Rheumatisms. 



The rheumatisms should be sep- 
arated especially from gout, arth- 
ritis, trichinosis, syphilis, tubercu- 
losis, and rickets. 

Acute Articular Rheumatism. — 
The affection of medium-sized joints 
and especially the flitting from 
joint to joint, are characteristic 
points. Atypical cases and cases 
that do not respond readily to treat- 
ment should arouse the suspicion 
that they are not cases of rheu- 
matism. Acute articular rheu- 
matism must be separated especially 
from other forms of rheumatism, 
involvement of the joints in septi- 
cemia, and gout and sarcoma. 

Chronic Articular Rheumatism. — 

The age of the individual, the num- 
ber of joints affected, longer dura- 
tion despite medication, and the ab- 
sence of sweating, high fever, or 
complications on the part of the 
heart, are important points in diag- 
nosis, and serve to differentiate 
chronic from acute rheumatism. 



Gonorrhoeal Rheumatism. — A 
preference is shown for the period 
of adolescence, the male sex, and 
the knee joint. There may be in- 
volvement of the ankle and joints 
of the foot. Usually the affection 
of the joints is observed within 
three months after the gonorrhoeal 
infection. The joints are greatly 
swollen. The disease runs a chronic 
course, as a rule, does not show 
sweating nor involvement of the 
heart, and when cured does not re- 
turn nor leave deformity. 

Muscular Rheumatism. — The char- 
acteristic symptom is pain, which 
may vary in all degrees of severity 
and character, and is confined to the 
voluntary muscles. The pain is usu- 
ally relieved by pressure. Myalgia 
must be differentiated from the in- 
fections, especially smallpox, tuber- 
culosis, syphilis, and septicemia; 
and aneurysm, caries of bone, and 
tumors must be excluded. The sep- 
aration from neuralgia is sometimes 
difficult. 



Diagnosis op Syphilis. 251 

Muscles. 

Rheumatic pains are present in the muscles during the 
second stage of syphilis, often as early symptoms of the irri- 
tative stage, probably due to a myositis. Now and then there 
is a marked myositis early in the course of syphilis. The 
muscle is tender, and the portion of muscle affected is usually 
contracted. These pains, that occur during the second stage 
of syphilis, may persist for weeks. The outlook, as to perfect 
recovery, is absolutely good. 

The third stage of syphilis is represented in the muscles 
by the gumma. This begins as a painful infiltration, some- 
times in the belly of the muscle, more often near a tendon. 
The muscle is rigid, usually contracted. The growth of the 
gumma is slow. When the process terminates in absorption, 
the destroyed muscular fibres are replaced by connective tissue. 
More frequently the gumma grows, to later involve the over- 
lying parts, including the skin, to which the tumor often 
becomes adherent. When the mass softens and discharges 
through the skin, there is formed a more or less sinous ulcer. 
Such a process runs a course of weeks or months. After heal- 
ing, the cicatricial contractions lead to more or less deformity. 
Motion is impaired, and the muscle is bound by the scar to 
the overlying structures and skin, and sometimes also to the 
periosteum. 

An interstitial infiltration may accompany gummata of the 
muscles or appear as an independent affection. The processes 
are usually associated. The muscular fibres become replaced 
by connective tissue. Thus, the muscles lose their contractility, 
but there is not left the great deformity that follows the 
sloughing of a gumma of the muscle. 

Syphilitic myositis ossificans has already been studied. 

Atrophy of muscles, either singly or in groups, may be 
caused by syphilitic affection of the nerves, which we will 
consider later. 

Of these various syphilitic affections of the muscles, the 
gumma is most frequently of diagnostic importance. Usually 



252 Diagnosis op Syphilis. 

gummata are multiple, but single gummata are occasionally en- 
countered. Such growths should be differentiated from neo- 
plasms, especially sarcoviata. The specific test for syphilis 
usually suffices to make this differentiation. Sometimes it is 
advisable to remove a piece of the suspicious growth for micro- 
scopic examination. In this connection, it must be remem- 
bered that the microscopic differentiation between gumma and 
sarcoma is often one of the most difficult to make. Actinomy- 
cosis has been mistaken for gummata. This is more liable to 
occur when there are multiple nodules, which is more char- 
acteristic of syphilis than of actinomycosis. In suspected 
cases the microscope will reveal the presence of the actinomyces. 
Enlargement of the spleen would speak for actinomycosis rather 
than syphilis. Such a case was reported by R. Koehler, in 
which Israel found post-mortem actinomycosis of the spleen, 
heart and lungs, and also cicatrices in the liver. Trichinosis 
often presents the picture of muscular rheumatism, with the 
history of meat poisoning. 

In aucte polymyositis, the symptoms are pain, tenderness, 
and loss of function in the affected muscles. The resemblance 
to trichinosis is indicated by Hipp's suggestion, that this affec- 
tion of the muscles be termed pseudo-trichinosis. Sometimes 
a differential diagnosis is impossible without examination 
of a section of the affected muscle. There is of ten a 
simultaneous involvement of the skin and muscles, derma- 
tomyositis. Acute parnchymatous myositis occurs after slight 
injuries, disturbances of the circulation, in the neighborhood 
of new growths, and in typhoid fever. 

Tendons. 

Reference has already been made to the fact that the gum- 
mata of muscles seem to show a distinct preference for the 
region of the tendons. 

Syphilitic affections of the tendon sheaths have been re- 
ported by a number of observers. Hygromata have been 
observed quite early in the course of syphilis. These are only 



Diagnosis of Syphilis. 253 

slightly painful. There may also be a true synovitis, marked 
by painfullness that is increased by motion. 

Bursae. 

Hygroma occasionally occurs early in the course of 
syphilis. The diagnosis is usually made by the concomitant 
symptoms of syphilis, and the Wassermann reaction, together 
with the disappearance of the hygroma under anti-syphilitic 
treatment. The fluctuating tumor may be somewhat tender, 
but is usually comparatively or absolutely painless. 

Gummatous bursitis is comparatively rare. Palpation may 
detect alternating points of fluctuation and the hard points 
formed by the gummata. Usually there is only slight tender- 
ness. Again, there may be great tenderness, and the mass may 
be either hard or soft. Usually the disease shows a tendency 
to break down. The growths respond to the therapeutic test 
when long continued. 

Fasciae. 

Nodular infiltrations may appear in the fasciae early in 
syphilis. Gumma of the fascia usually involves the muscles, 
though there are exceptions to this rule. The diagnosis is 
made by the Wassermann reaction, the presence of other evi- 
dences of syphilis, and the disappearance of the affection of 
the fascia under anti-syphilitic treatment. 



254 Diagnosis of Syphilis. 

SYPHILITIC AFFECTIONS OF THE NERVOUS 
SYSTEM. 

Brain and Meninges. 

During the second stage of syphilis there may be symp- 
toms of brain irritation or of irritation of the meninges. 
Among these symptoms, the more common are headache, ver- 
tigo, and general irritability ; less often there is nausea. 
There is rarely fever or acceleration of the pulse. These 
symptoms last for but a few days, with a return to the normal 
as the rule. The headache may be general ; over the entire 
head, or frontal or occipital. Bands of pain extending over 
the head from ear to ear have been described, as have also 
pains encircling the head horizontally. Rarely there is irreg- 
ularity of the pupils or slowing of the pulse. Ophthalmoscopic 
examination will reveal often irritation of the choroid and at 
times of the retina. The irritation of the retina may be 
marked, though there is little or no disturbance of vision. 

The spirochete pallida may be found, especially in the 
blood and cerebrospinal fluid, to make the diagnosis of syphilis 
absolute. Often the diagnosis may be cleared up by the 
Wassermann reaction. The search for the spirochete pallida 
is of most value during the second stage of syphilis ; during 
the third stage, it is more difficult to make. The Wassermann 
reaction is present in all stages of syphilis, when the disease 
process is active. It may sometimes not be found if the patient 
has received anti-syphilitic treatment. 

True meningitis is usually due to caries or necrosis of the 
bones of the skull. Frequently syphilitica show symptoms of 
pachymeningitis, especially a constant pain in the head, that 
is frequently localized, and may be increased by percussion. 
Pachymeningitis hemorrhagica is comparatively rare. Hydro- 
cephalus internus, ependymitis with hydrops, has been observed 
in syphilis. The softening of the brain, observed in some cases 
of syphilis, is due as a rule to a syphilitic endarteritis. The 
endarteritis seems to prefer the carotids and their branches, the 



Diagnosis op Syphilis. 255 

arteriae fossae Sylvii et corporis callosi, especially in their 
first portions. This is the source of the terminal arteries of the 
lenticular nucleus and the caudate nucleus, where softening 
most frequently occurs. Hemorrhages in the brain are rather 
frequent in syphilis, being due as a rule to aneurysms, which 
are frequently found in the diseased vessels of syphilitics. 

Gummata of the dura mater develop between the folds of 
the dura, and show a preference for the duplications of the 
membrane, such as the falx cerebri. The gummata may be 
extensive or circumscribed, frequently the size of a walnut or 
larger. These growths sometimes cause erosion of the con- 
tiguous portion of the skull. 

Gummata of the pia mater lead to adhesion with the dura 
and also with the contiguous portion of the brain. When 
located upon the upper and lateral portions, the white sub- 
stance is not infrequently involved, often without softening of 
the brain. Gummata of the pia, when located at the base of 
the brain, are not so likely to involve the dura. Meningeal 
gummata may be diffuse, at first appearing as a jelly-like infil- 
tration, that later becomes converted into a cicatricial mem- 
brane. 

Meningitis gummosa basilaris diffusa has the unenviable 
reputation of being the most frequent syphilitic affection of 
the brain. It seems to prefer the region of the chiasm, fre- 
quently involving the oculomotor, optic and other cerebral 
nerves. The convexity is less frequently involved. 

Gummata of the brain, in the absence of affection of the 
meninges, must be regarded as rare. In such cases, the arteries 
in the region involved, will be affected as a rule by an oblit- 
erating endarteritis, that leads to softening of the brain. 

Syphilis frequently seems to play an etiological role in the 
production of a number of diseases that can not always be said 
definitely to be syphilitic, such as ophthalmoplegia, immobility 
of the pupils, atrophy of the optic nerve, dementia paralytica, 
and locomotor ataxia. 

Headache is one of the most common symptoms of syphilis 
of the brain and meninges. The headache may be general or 



256 Diagnosis of Syphilis. 

localized, and occurs in all grades of severity. Usually the 
headache is more or less continuous, rarely showing distinct 
intermissions, though exacerbations are the rule. The exacer- 
bations are often nocturnal, though this characteristic is not 
peculiar to syphilis, as is sometimes taught. The duration of 
syphilitic headache varies greatly. Thus, the headache due 
to meningeal irritation, which occurs especially as a symptom 
of the second stage of syphilis, usually does not last longer 
than a week or two, when the case is under proper treatment, 
and several weeks possibly in cases not treated. Sometimes the 
patients complain of headache of a recurrent type, with 
intervals of a number of weeks or months, in which cases there 
are probably multiple causes and the location of the pain often 
changes. Long continued localized headache may be due to 
neuralgia, which may involve either superficial or deep nerves, 
for instance in the dura. With tlic headache there is often 
vomiting, less often vertigo. Frequently neuralgia is accom- 
panied by insomnia, irritability and various parasthesis. Irri- 
tability (motor, sensory or mental), various paralyses and 
degradation of the intelligence and power of thought, as well 
as various psychoses, are frequently observed in syphilis, though 
they may be due to other diseases. Brain syphilis of long dura- 
tion is frequently accompanied by obstruction to the power of 
thinking, lessened concentration or loss of memory, together 
with unconsciousness and convulsions. 

In brain syphilis, the pulse may show various changes. Fre- 
quently the pulse is slow, like in tumor of the brain ; again the 
pulse may be fast or irregular. Cases ma}' show polyuria and 
polydipsia. 

Optic neuritis or choked disk, with the vision normal or dis- 
turbed in various ways, may be found in brain syphilis. But a 
chronic optic neuritis would rather argue against syphilitic 
brain tumor (Gowers). 

Functional or focal symptoms may enable us to locate the 
region in the brain involved in the syphilitic process. In all 
brain affections of an obscure nature, it is well to think of 
syphilis. Such cases justify the therapeutic test. 



Diagnosis of Syphilis. 257 

Hydrocephalus internus syphiliticus, ependymitis syph- 
ilitica, shows violent headache as a prominent symptom. The 
headache is continuous, often with marked exacerbations, and 
is frequently accompanied by nausea and vomiting. The latter 
symptoms may sometimes be caused by movements of the head 
or change of position. 

Cerebral syphilis may produce a monoplegia, hemoplegia, 
an epilepsy, a pseudo-chorea, aphasia, alexia, disturbances of 
hearing due to affection of the auditory center in the temporal 
lobe. Affections of the eye may be due to syphilitic affection 
of any part of the optic tract from the cortex to the eye. This 
gives an idea of the variety of affections that may be caused 
by cerebral syphilis. Space forbids entering into the details 
of cerebral localization. All suspicious cases should be sub- 
jected to the therapeutic test, when this is practicable. 

The base of the brain is frequently the seat of diffuse or 
circumscribed gummata. Here, again, the gummata often 
begin in the meninges. A useful point in diagnosis is the 
fact that syphilis of the convexity of the cerebrum is marked 
by cortical symptoms, whereas syphilis of the base of the brain 
is prone to involve the cerebral nerves of this region. Basilar 
meningitis is frequently accompanied by affection of the spinal 
meninges and by syphilis of the spinal cord. Furthermore, 
affection of the cerebral arteries at the base of the brain often 
leads to hemorrhages and softening. It is remarkable how 
extensive lesions are sometimes found post-mortem with the 
history of little disturbance during life. 

We have referred to involvement of the cerebral nerves. 
It is possible for syphilis to affect a single cerebral nerve, but 
frequently there is affection of a number of these nerves. 
Thus, when the olfactory and optic nerves are affected, the 
process may extend back to affect also the trochlears, trige- 
minus and abducens, and possibly the facial and auditory 
nerves. Posteriorly, the process may involve the hypoglossus 
and vagus. The optic chiasm seems to be a favorite location 
in basilar syphilis, and in these cases the ocular muscles are 
affected. 



258 Diagnosis of Syphilis. 

H. Oppenheim regards oscillating hemianopsia bitemporalis 
as characteristic of syphilis of the base of the brain. He 
ascribes the appearance and disappearance of the symptoms 
in these cases to the presence or absence of swelling of the 
tissue in this region. 

Crossed paralysis is referred by Nothnagel to affection of 
the cerebral peduncles. In these cases the cerebral nerves, 
especially the oculomotor, will be affected on the side of the 
lesion, and the extremities of the opposite side. This is the 
so-called hemiplegia alternans superior. Similar symptoms may 
be caused by syphilitic basilar meningitis. Nothnagel believes 
that an alternating paralysis appearing at the same time points 
to a lesion in the cerebral peduncles. 

Hemiplegia alternans inferior, in which the crossed hemi- 
plegia affects the facial on the side of the affected peduncles 
and the opposite side of the body, is explained by the cross- 
ing of the motor fibres passing from the cerebral cortex to 
the spinal cord, which takes place lower down in the pyramids. 

Affection of the pons affects the facial more frequently 
than when the process is located in the peduncles. In addition 
there is usually disturbance of speech and deglutition. Soft- 
ening of the pons, due to syphilitic arteritis, may cause the 
symptoms of acute bulbar paralysis. 

Lesions in the region of the corpora quadrigemina usually 
cause bilateral affection of the oculomotors, and also disturb- 
ance of equilibrium and co-ordination, similar to affection of 
the cerebellum. 

Lesions in the cerebellum cause disturbance of equilibrium 
and a peculiar gait. There are comparatively few cases of 
syphilis in this region reported. 

Affection of the medulla oblongata is always grave. These 
cases frequently run the course of an acute bulbar paralysis. 
In some cases a cure has followed anti-syphilitic treatment. 

So much for syphilitic affection of the meninges and the 
cerebral cortex. We will now turn to syphilis of the deeper 
portions of the brain. 

In the deeper portions of the brain syphilis most frequently 



Diagnosis op Syphilis. 259 

causes softening and hemorrhages. Gummata, both circum- 
scribed and diffuse, are comparatively rare. Most of the 
trouble in this region is due to syphilis of the cerebral vessels. 

Affections in the neighborhood of the central ganglia pro- 
duce symptoms chiefly through involvement or pressure upon 
the motor tracts, especially the internal capsule. If these tracts 
are not involved, lesions of the cerebral ganglia may be present 
without symptoms. 

Syphilitic affection of the cerebral vessels may lead to oc- 
clusion of these vessels gradually through ah obliterating en- 
darteritis, or suddenly through thrombosis. Furthermore, 
weakening of the vessel walls may lead to the formation of 
aneurysms, either sacculated or dissecting. These are well 
described in Schmaus' Pathology. Affection of the endar- 
teries, at the base of the brain, occluding these vessels, almost 
invariably leads rapidly to softening of the area supplied by 
the endartery. On the other hand, the vessels of the cortex 
more frequently anastomose, so that there is a possibility of a 
collateral circulation being established when a vessel in this 
region is occluded. 

It is evident that affection of the cerebral vessels may lead 
to a number of cerebral symptoms. Thus, there may be head- 
ache and vertigo, insomnia, mental irritability, and paresthesia?, 
especially formication, a day or two preceding the paralysis 
of a part. Hemiplegia or hemiparesis may appear suddenly 
without loss of consciousness, or be preceded by an apoplecti- 
form attack. Paralysis may disappear suddenhy or gradually. 
H. Oppenheim has observed that occasionally a central lesion 
may cause hemianesthesia, aphasia, and hemianopsia. The 
cases of partial occlusion of a vessel are prone to render prom- 
inent the vacillating character of cerebral symptoms, often 
regarded as characteristic of syphilis. Aneurysm, before burst- 
ing, may cause much the same symptoms as tumor. Later the 
vessel may be occluded by thrombi or emboli, when there will be 
added the symptoms of more or less complete occlusion of the 
artery, with consequent ischaemia or softening of the brain 
area supplied. Usually the aneurysms burst, with the symp- 



260 Diagnosis of Syphilis. 

toms of cerebral hemorrhage. In the diagnosis of the cause 
of affection of the cerebral arteries, early age speaks for 
syphilis as against arteriosclerosis. 

Syphilis of the brain usually produces multiple lesions. 
Both the circumscribed and diffuse gummata are usually ac- 
companied by syphilitic arteritis. Syphilitic basilar menin- 
gitis is often accompanied by an extension of the process to 
the spinal meninges. In such cases the spinal symptoms are 
added to the cerebral symptoms, though the latter often over- 
shadow the former. 

Often marked cerebral changes, especially the psychoses, 
are observed clinically in syphilitics, in cases that show no 
recognizable lesion post-mortem. Furthermore, marked anatom- 
ical lesions, such as extensive gummata, may be found post- 
mortem without the clinical evidence of brain affection during 
life. In many cases the general cerebral symptoms are fol- 
lowed by focal lesions only after the lapse of a long time, or 
not at all. 

Epilepsy and hysteria and mania have been observed early 
in the second stage of syphilis, and sometimes late in the dis- 
ease. Delirium and disturbances of the intelligence have also 
been observed. In such cases, the absence of other etiological 
factors will often point to syphilis as a possible cause. The 
therapeutic test is often suggestive. Cerebral syphilis usually 
runs a chronic course, though extreme chronicity would speak 
against cerebral syphilis ; some cases run an acute course. 

Syphilis often plays an important role in diseases of the 
nervous system, sucli as epilepsy and hysteria. Thus, in 
individuals predisposed to these affections, the occurrence of 
syphilis may be sufficient to cause the appearance of the cere- 
bral disturbance. Furthermore, syphilitics seem more prone to 
development of lesions of the nervous system. 

It is possible that mental exertion may predispose to the 
localization of syphilis in the nervous system. Worry and 
excessive devotion at the shrine of Bacchus and of Venus, are 
also prominent causes of affection of the brain in syphilitics. 



Diagnosis op Syphilis. 261 

The matter is put very succintly by Gray* when he says 
that we should suspect intra-cranial syphilis if there are 
present : 

1. Quasi-periodical headache that returns at a certain time in the 
twenty-four hours, most frequently at or toward night, less frequently in 
the afternoon or morning. 

2. Paralytic or convulsive symptoms that have been preceded by this 
characteristic headache and insomnia, when the headache and insomnia will 
have suddenly ceased upon the supervention of the paralysis or convulsion. 

3. Symptoms indicative of a lesion at the base of the brain, preceded 
or not by the characteristic headache and insomnia. 

4. Convulsions in the adult which have not been preceded by con- 
vulsions in infancy, and are not of traumatic or nephritic origin, or due 
to pregnancy, or in an individual subject to migraine. 

5. Hemiplegia in an adult under forty years of age, even when there 
has been no preceding headache and insomnia. 

6. A comatose condition extending over days or weeks, not traumatic, 
meningitic, diabetic, nephritic, or from typhoid fever. 

Often great stress is laid upon the value of the test for 
syphilis with iodide of potassium, in cerebral syphilis. In this 
connection it must not be forgotten that iodide of potassium 
often seems to cause marked improvement in non-syphilitic 
brain tumors. As a rule, the syphilitic tumors of the brain, 
under proper treatment, give a better prognosis than non- 
syphilitic brain tumor. The outlook depends largely upon the 
severity, duration and repetition of the paralyses and other 
symptoms. We must consider the possibility of death or re- 
covery, decrease and increase of the paralyses and other symp- 
toms, and also the termination in idiocy, delirium that passes 
into general paralysis, and fatal coma. At the same time we 
must remember the possibility of complications, such as hypo- 
static pneumonia, and bedsores with consequent sepsis. 

Spinal Cord and Meninges. 

Spinal syphilis is not so common as cerebral syphilis. Early 
in the course of syphilis there may be symptoms of spinal 
meningeal irritation. Thus, early in the second stage the 
patient may experience pain and paresthesias in the lower 
extremities, together with a feeling of debility. Lang ascribes 
these symptoms to hyperemias or slight infiltrations of the 
spinal cord or meninges, and believes that it may possibly 



*A treatise on nervous and mental diseases, by Landon Carter Gray 



262 Diagnosis of Syphilis. 

change from an irritation to a distinct meningitis or menin- 
gomyelitis spinalis. 

An increase of the skin and tendon reflexes has been re- 
ported early in the second stage of syphilis, the irritability of 
these reflexes at first increasing and later decreasing below the 
normal, to later gradually again return to the normal. The 
change begins about the time the eruption appears, and the 
normal condition is not reached until several weeks after the 
eruption disappears. 

True spinal meningitis may, though rarely, be caused by 
syphilitic vertebral periostitis. Gummata of the spinal me- 
ninges or of the spinal cord are rare. Affection of either the 
spinal meninges or of the cord usually involves the spinal 
nerves. Syphilitic affection of the blood vessels may affect the 
cord. As stated, syphilis of the cord often occurs in associa- 
tion with syphilis of the brain, when it is frequently over- 
shadowed by the latter. 

Spinal syphilis usually presents, in addition to the symptoms 
of syphilis in other parts of the body, symptoms on the part 
of the spinal meninges, and also symptoms due to the affection 
of the spinal cord. Sometimes the physician ma}' not be able to 
find evidences of syphilis in other parts of the body, and rarely 
the meninges may lie affected without involvement of the cord. 

Among the early symptoms of spinal syphilis are stiffness 
of the spinal column, neuralgia, and girdle pains or pares- 
thesia;. The patient complains of heaviness of the extremities. 
There may be alterations of sensibility, especially minor altera- 
tions, as for heat and cold, etc. 

When the process attacks the cord and involves the various 
spinal tracts, the resulting paralyses and pareses may enable 
us to locate the seat of the morbid process. The higher the 
lesion in the cord, the more extensive will be the resulting 
paralyses and pareses. Thus, lesions in the dorsal or lumbar 
portion of the spinal cord may cause more or less complete 
paralysis of the abdominal and intercostal muscles, and para- 
phlegias of the lower extremities, and paralvsis of the sphinc- 
ters. Lesions in the cervical portion of the cord are marked 



Diagnosis of Syphilis. 263 

by pain, paresthesias and stiffness of the neck, and affection of 
the lower portion of the body as a rule appears later. Affec- 
tion of the thoracic muscles and the diaphragm is marked by 
dyspnoea and attacks of asphyxia. Affection of only one side 
of the cord in any of these regions will cause a corresponding 
affection of half of the body. At times the involvement of 
the cervical portion of the cord is marked by an ascending 
paralysis, affecting successively the lower extremities, the sphinc- 
ters, the lower part of the trunk, and later the upper extremities 
and the muscles of respiration. 

All cases of spinal syphilis offer a grave prognosis. Even 
when only the lower extremities and sphincters are affected, 
cystitis and decubitus may lead to a fatal termination. Paralysis 
of the respiratory muscles may lead to a fatal pneumonia or 
gangrene of the lung. Sudden asphyxia may be caused by 
paralysis of the phrenic nerve. But in all cases, even those 
that appear the most grave, improvement or cure may follow 
the proper treatment of the disease. When improvement occurs, 
the paralyses usually disappear in the reverse order of their 
appearance. Thus, improvement is noted first in the muscles 
of respiration, possibly, and later in the paralysis of the trunk, 
of the upper extremities, and later of the sphincters and of 
the lower extremities. Often there remains for a long time 
weakness of the muscles that have been affected, pains and 
paresthesias and abnormalities of sensation. Any degenerative 
changes that may have been caused by the process in the cord 
will remain, of course, to cause permanent affection of the area 
involved. 

Many observers have noted that syphilis of the cord usually 
develops gradually and frequently accompanies brain syphilis, 
and the process tends to descend. But in many cases the affec- 
tion of the cord seems to come on suddenly, and at times the 
lesion seems to extend from below upwards. 

Great diagnostic aid may be secured by an examination of 
the cerebrospinal fluid for the spirochete pallida. The spiro- 
chete may also be found in the blood, in S3>philis. The Wasser- 
mann reaction will often render valuable aid in clearing up 
obscure cases. 



264 Diagnosis of Syphilis. 

In meningomyelitis syphilitica there is not infrequently 
marked fluctuation of the symptoms, especially disappearance 
and reappearance of the patellar reflex. 

Occasionally spinal syphilis runs its course as an acute, 
subacute or chronic myelitis. 

Rarely paraplegia occurs suddenly, when it is usually due 
to an endarteritis causing thrombosis or hemorrhage. 

A pseudotabes syphilitica is occasionally encountered, 
marked by loss of the knee-jerk, the presence of lancinating 
pains, ataxia, immobility of the pupil, vesical disturbance, 
gastric crises, etc. The condition is due to meningitis spinalis 
syphilitica that affects especially the posterior columns and the 
posterior roots. 

Spinal syphilis sometimes shows successive exacerbations, 
resembling somewhat the clinical picture presented by multiple 
sclerosis. Multiple sclerosis, however, presents other symptoms, 
such as tremor of the muscles when in motion and not when at 
rest, hesitating speech, and nystagmus, that usually suffice to 
make the diagnosis. Symptoms of meningeal irritation would 
speak for spinal syphilis and against multiple sclerosis. 

Cases of syphilitic progressive muscular atrophy have been 
reported. A point of differentiation from the non-syphilitic 
progressive atrophy is the presence of pain and paresis before 
the atrophy of the muscles. 

The syphilitic spinal paralysis of Erb is due to the gradual 
development of meninglomyelitis. There is a weakness of the 
lower extremities, rarely an actual paraplegia. The gait be- 
comes spastic. The legs are stiffened and locomotion is diffi- 
cult. However, muscular rigidity and contracture are usually 
only slight. The knee-jerk is increased. Vesical weakness and 
impotence are present. Muscular atrophy is absent ; electrical 
irritability is present. The disease does not involve the nerves 
of the arms or head. The disease occurs usually from one to 
three years after infection, rarely from five to twenty years. 
Usually the affection responds to anti-syphilitic treatment. 
Grave cases may be incurable or fatal. 

The spasmodic tabes dorsalis of Charcot, or the spastic 



Diagnosis of Syphilis. 265 

paralysis of Erb, is believed by some to be due to syphilis. The 
spastic paralysis is the characteristic feature. These cases usu- 
ally do not show sensory disturbances nor affection of the bladder 
or rectum. 

Among the comparatively rare affections is a multiple syph- 
ilitic root neuritis due to gummatous meningitis. Of the 
cerebral nerves, the oculomotors and the facials are most fre- 
quently affected. In the spinal cord, the cervical and dorsal 
portions are most frequently involved, to affect either the anterior 
or posterior roots upon one or both sides. There is a gradual 
development of progressive paralysis. There may or may not 
be symptoms of cerebral or spinal syphilis. There are gradu- 
ally increasing neuralgias of the spinal nerves and hyperesthesias 
of the skin or girdle pains. Affection of the anterior nerve 
roots leads gradually to motor palsies. There is usually little 
response to anti-syphilitic treatment. 

Tabes dorsalis is usually found in individuals who present 
the evidence or history of a previous syphilitic infection. But 
he would be a bold man, indeed, who would presume to declare 
that tabes is always due to syphilis. The fact remains, how- 
ever, that syphilis seems to play an important role in the 
etiology of tabes. To such a degree is this true, that the pres- 
ence of tabes dorsalis justifies the presumptive diagnosis of 
syphilis, though a positive diagnosis of syphilis in these cases 
could only be made in the presence of other symptoms or evi- 
dence of that disease. Anti-syphilitic treatment is usually of no 
value, so that the therapeutic test fails us in these cases. Of 
most diagnostic value is the Wassermann reaction. 

Peripheral Nerves. 

Aside from affection of the peripheral nerves by brain or 
spinal syphilis, these nerves may be affected by the pressure of 
gummatous infiltrations in the bones, periosteum, muscle and 
fascia through which the nerves pass. In most cases the lesion 
causing affection of these nerves, manifested by neuralgia and 
paralysis, escapes detection. 

Frequently neuralgia is due to syphilis. A painful ring 



266 



Diagnosis op Syphilis. 



extending over the skull from ear to ear and two or three fingers 
wide, sometimes observed in syphilis, is believed to be due to 
meningeal irritation. 

Peripheral neuralgia may appear early in the second stage 
of syphilis, or later in the course of the disease, even years after 
the primary infection. The early cases may be due to a simple 
syphilitic irritation that does not leave permanent anatomic 
alterations. Gummata are comparatively rare in the nerves, 
though neuralgia not infrequently is caused by the pressure of 
gummata in other tissues. Such a gumma may extend to the 
nerve, to destroy the nerve or to cause a neuritis or a 
perineuritis. 

Trigeminal neuralgia is most frequent. Any of the branches 
may be involved, or all of them. Occasionally a single branch, 
such as the supraorbital or the lingual, may alone be involved. 
The neuralgia usually disappears under anti-syphilitic treat- 
ment. 

Peripheral neuralgias of the spinal nerves are not so com- 
mon. Thus, neuralgia of the occipitalis major and of the nervus 
auricularis inagnus have been observed to disappear under anti- 
syphilitic treatment. Neuralgia of the brachial plexus is not 
common, but such a neuralgia has been observed, apparently 
due to the pressure of enlarged lymph nodes. 

Intercostal neuralgia may be found early in the second 
stage, as an irritative symptom of syphilis. Occasionally inter- 
costal neuralgia is caused by syphilitic periostitis of the ribs. 

Syphilis is frequently a cause of sciatica. The sciatica is 
frequently due to syphilitic perineuritis. The etiologic role 
played by syphilis is revealed by the response of the sciatica 
to the anti-syphilitic treatment. 

Visceral neuralgias arc frequently observed in syphilis. 
These are usually duo to affection of the internal organs, such 
as the heart, intestine, etc., or of the arteries (coronary arteries) 
or lymphatics, and possibly at times affection of the correspond- 
ing nerves. 

Paralysis is a prominent symptom of syphilis. Reference 
has already been made to the paralysis due to brain and spinal 



Diagnosis of Syphilis. 267 

syphilis. Syphilitic peripheral paralysis is far more frequently 
observed in the cranial nerves. The peripheral paralyses at 
times appear and disappear suddenly. 

Perhaps the most frequent paralysis is that of the oculo- 
motor, which in fully half the cases is due to syphilis. The 
paralysis may affect the oculomotor in its entirely, or only a 
single branch may be involved. 

Facial paralysis is frequent in the second stage of syphilis, 
often appearing within a year after infection. The paralysis 
disappears as a rule completely under anti-syphilitic treatment. 
Syphilitic facial paralysis is sometimes recurrent, and the affec- 
tion may be bilateral. A bilateral facial paralysis, accompanied 
by paralysis of other cerebral nerves (auditory, oculomotor, 
abducens, trigeminus, and hypoglossal) speaks for syphilis at 
the base of the brain. 

Peripheral paralysis of the other cerebral nerves is rare. 
They are more often affected by brain syphilis. 

BASAL GUMMATOUS MENINGITIS. 

Headache is present in about three-fourths of cases, and frequently 
occurs as one of the most important early symptoms. It is usually worse 
at night. The pain may be sharp, boring or dull, superficial or deep 
seated, rarely circumscribed. Other important symptoms are: 

Nauralgias. 

Cerebral vomiting and vertigo. 

Alterations of mentality, such as somnolence, semi-intoxication, or im- 
pulsive, motiveless activity, and losse of the aesthetic sense. 

Coma, with the possibility of spontaneous recovery. Persistent sleep 
is ominous. 

Alterations in brain activity, which may be tardy or excited. There 
may be nocturnal automatism or dementia, alternating with delirium, 
epileptic attacks, or paralytic seizures. The brain symptoms rarely re- 
semble those of uremia, meningitis, or typhoid fever. Epilepsy may be 
typical or unilateral, frequent or violent: and tetanic or cataleptic seizures 
may occur. 

Polyuria, polydipsia, diabetes insipidus, and diabetes mellitus occur. 
Fever may be irregular. 

Affection of cerebral nerves, especially the third nerve, which is affected 
in more than half of the eases, and the optic nerve, which is affected in 
over half of the cases. Choked disk, usually bilateral, occurs in ten per 
cent, of cases-, neuritis, unilateral, in about five per cent, of cases; simple 
atrophy with blindness, amaurosis, hemianopsis. 

The fourth, sixth, and fifth nerves are affected less frequently, in the 
order given. 

The olfactory nerve is rarely involved. The facial may be affected 
unilaterally, peripherally. The eighth nerve is sometimes involved. The 
vagus or hypoglossus may be affected. 



268 



Diagnosis of Syphilis. 



Localization of the Functions. 



SEGMENT. 
Second and third cervical. 

Fourth cervical. 



Fifth cervical. 



Sixth cervical. 



Seventh cervical. 



Eighth cervical. 
First dorsal. 

Second to twelfth dorsal. 
First lumbar. 

Second lumbar. 
Third lumbar. 



MUSCLES. 

Sternomastoid, trapezius, 
Scaleni and neck, 
Diaphragm. 

Diaphragm, 

Deltoid, 

Biceps, coracobrachialis, 

Supinator longus, 

Rhomboid, 

Supra — and infra spinatus. 

Levator angnla scapula?. 

Deltoid. 

Biceps, coracobrachialis, 

Supinator longus, 

Supinator brevis, 

Deep muscles and shoulder blade, 

Rhomboid, teres minor, 

Pectorali8 (clavicular part), 

Serratus magnus. 

Biceps, brachialis anticus, 

Pectoralis (clavicular part), 

Sena I us magnus, 

Triceps, 

Extensors of wrist and fingers, 

Pronators. 

Triceps (longhead), 

Extensors of wrist and fingers, 

Pronators of wrist, 

Flexors of wrist, 

Subscapular, 

Pectoralis (costal part), 

Lai issimus dorsi, 

Teres major. 

Flexors of wrist and fingers, 
Intrinsic muscles of hand. 

Extensors of thumb, 

Intrinsic hand muscles, 

Thenar and hypothenar eminences. 

Muscles of back and abdomen, 
Erectores spina?. 

Quadratus lumborum, 
Transversalis obliqui, 
Ilio-psoas, 
Sartorius. 

Ilio-psoas, sartorius, 
Flexors of knee ( Remak ) , 
Quadriceps femoris. 

Quadriceps femoris, 
Inner rotators of thigh. 
Obturator, 
Adductors of thigh. 



Diagnosis op Syphilis. 



269 



The Segments of the Spinal Cord (M. Allen Starr). 



REFLEX. 

Hypoehondrium ( ?) 

Sudden inspiration, produced by- 
sudden pressure beneath the 
lower border of the ribs. 

Pupil, fourth to seventh cervical. 
Dilation of the pupil produced by 
irritation of the neck. 

Scapular, 

Fifth cervical to first dorsal. 

Irritation of skin over the scapula 

produces contraction of the 

scapular muscles. 
Supinator longus. 
Tapping its tendon in wrist produces 

flexion of forearm. 

Triceps. 

Fifth to sixth cervical. 

Tapping elbow tendon produces ex- 
tension of forearm. 

Posterior wrist. 

Sixth to eighth cervical. 

Tapping tendons causes extension of 
hand. 

Anterior wrist. 

Seventh to eighth cervical. 

Tapping anterior tendon causes flex- 
ion of wrist. 

Palmar, seventh cervical to first 
dorsal. 

Stroking palm causes closure of fin- 



SENSATION. 

Back of head to vertex. 
Neck. 



Outer part of shoulder. 



Back of shoulder and arm. 
Outer side of arm and forearm. 



Outer side of arm and forearm. 
Outer half of hand. 



Front, back of arm and forearm. 
Middle and ring fingers. 



Epigastric, fourth to seventh dorsal. 

Tickling mammary region causes re- 
traction of the epigastrium. 

Abdominal, seventh to eleventh dor- 
sal. 

Stroking side of abdomen causes re- 
traction of belly. 

Cremasteric, first to third lumbar. 
Stroking inner thigh causes retrac- 
tion of scrotum. 

Patella tendon. 

Striking tendon causes extension of 
leg. 

Bladder center. 

Second to fourth lumbar. 



Forearm and hand; ulnar area. 
Inner side of forearm. 

Skin of chest and abdomen, in bands 
running around and downward, 
corresponding to spinal nerves. 



Skin over groin and in front of scro- 
tum. 



Outer side of hip. 
Front of thigh. 

Front of thigh. 
Inner side of leg. 



270 



Diagnosis of Syphilis. 



Fourth lumbar. 



Fifth lumbar. 



First and second sacral. 



Third sacral. 

Fourth and fifth sacral. 



Adductors of thigh, 
Abductors of thigh, 
Flexors of knee (Ferrier). 

Glutei, 

Biceps femoris, 

Sc;nitendinosus, 

Popliteus, 

Outward rotators of thigh, 

Flexors of knee (Ferrier). 

Biceps femoris, 

Semimembranosus, 

Extensor longus digitorum, 

t.astric, 

; ibiclia posticus 

Tibialis anticus. 

Peronei, 

Intrinsic muscles of foot. 

Sphincter ani et vesicae, 
Perineal muscles. 



Gummata in the pons, eras or medulla, may cause hemiplegia and 
crossed paralysis — hemiplegia and 

(1) Oculo-motor paralysis, "i 

(2) Facial paralysis, oi 

(3) Abducens and trigeminus paralysis. 

Arterial phenomena: 

(1) In cortical region — syncope or apoplectiform attack from 

variation in blood pressure. 

(2) In central ganglia — encephalomalacia. hemiplegia, hemianes- 

thesia, and hemianopsia. These usually occur later than 
meningitis and neuritis. 

Duration — With remissions and exacerbations, a few months, rarely 
more than six. in the absence of treatment. 



Diagnosis of Syphilis. 



271 



Rectal center. 

Fourth lumbar to second saeral. 
Gluteal. 

Fourth to flfth lumbar. 
Stroking buttock causes dimpling 
in fold of buttock. 

Achilles tendon. 

Over-extension causes rapid flexion 
of ankle, called ankle clonus. 

Babinski reflex. 

Scratching sole of foot causes exten- 
sion of great toe. 

Fifth lumbar to first saeral. 



Outer and back side of thigh and 

front of leg to ankle. 
Dorsum of foot. 



Leg and foot, outer part. 



Plantar. 

Tickling of sole of foot causes flex- 
ion of toes and retraction of 
leg. 



Back of thigh and leg in saddle- 
shaped area. 
Inner side of foot. 



Back of buttock, seat. 



Perineum, anus. 
Back of scrotum. 



From M. Allen Starr — Localization of the functions of the segments 
of the spinal cord. 



Cancer at the Base of the Brain. 

Course more continuous and progressive. Intermittent or remittent 
in syphilis. 

Definite localization. Localization varies in syphilis. 

Few changes in the vessels. Changes in vessels may be marked in 
syphilis. 

Tubercuxous Meningitis. 

Less development of connective tissue. 

Vascular changes are rarer. 

Nerves less frequently involved. 

Course more acute, febrile, and progressive. 

Remissions less frequent and less marked. 



272 Diagnosis op Syphilis. 

Stiff neck and general muscular rigidity occur — rare in the congenital 
type of syphilis. 

Mental obscurity more marked and sudden, and not marked by the 
intermissions observed in syphilis. 

Early irritation, followed by paralysis; paralysis occurs at once in 
syphilis. 

Age: Tuberculous meningitis is more frequent under twenty-five; 
syphilitic meningitis usually occurs after twenty-five. 

Other evidences of tuberculosis are present as a rule. 

Syphilis of the Convexity. 

May occur as circumscribed or diffuse meningitis or meningo-ence- 
phalitis, with symptoms like those of cortical tumor or with diffuse 
manifestations. 

Headache is one of the early symptoms. 

Convulsions, may occur as the first evidence of the disease. After 
thirty, convulsions indicate syphilis, in ninety per cent, of cases, in the 
absence of uremia and alcohol as causes. — (Fournier.) 

Focal symptoms, Jacksonian epilepsy with monoplegia or hemiplegia. 

Pain and paresthesia occur; anesthesia is rare. 

Aphasia is frequent, of the transitory motor type, due to vascular 
disease more frequently than to gumma. 

Acute psychoses may occur, most frequently as dementia, when the 
process is diffuse. 

Syphilitic Abtebial Disease. 

May occur alone or with other varieties of brain syphilis. 

Most frequent form. Next to affection of the nerves, this is the most 
frequent cause of paralysis. 

Prodromal distubraiwes: Headache is the rule, but less constant than 
in meningeal syphilis. 

Vomiting, vertigo, dullness, psychic changes, dementia, convulsions, 
intermittent hemianopsia, and aphasia are prominent symptoms. Choked 
disk is rare. Thrombosis and obliteration of the vessels is gradual in 
onset and is intermittent — may involve the leg and in a few hours or 
days the arm. These changes are due to obliteration of the vessels and 
multiple softening, which occurs in ninety-five per cent, of the cases in 
the region of the artery of sylvius pseudobulbar paralysis and may result 
from involvement of the bulbar vessels. 

The attacks, at first mild and short, increase in severity. 

Arteriosclerosis usually occurs later in life, is slower in progress, and 
the changes are more disseminated. 

Average duration, without treatment, one to three months. Basal 
gummatous meningitis rarely lasts over six months. 

Gummata. 

May occur in any part of the brain or meninges. 

Cortical pummafa— cortical epilepsy and monoplegia. Should be dif- 
ferentiated from other tumors, especially tubercle and glioma. 

Cortical tumor: Headache duller and deeper; pressure symptoms, 
mental depression, and slow pulse more marked; disk changes follow focal 
symptoms; the process advances less by epochs. 

In syphilis: Headache is frequently local, pressure symptoms more 
diffuse, due to more rapid and extensive involvement ; disk involved usu- 
ally only in the presence of basal meningitis: cortical paralysis, often 
associated with Jacksonian epilepsy; improvement under anti-syphilitica 
is permanent. 



Diagnosis of Syphilis. 273 



Cebebrospinai, Syphilis. 

The symptoms are asymmetrical and less pronounced. 

The disease responds tomercury and the iodides. 

The symptoms are variable. 

The symptoms are variable. Meningeal and nerve root symptoms as- 
sume prominence. Syphilis of the cord is less frequent than syphilis of 
the brain. 

Varieties of cerebrospinal syphilis: 

( 1 ) Gummata of bones — exceptional, as are also exostoses and caries. 

(2) Gummatous meningitis — most frequent. 

(3) Meningomyelitis — the myelitis occurring secondary to meningitis. 
(Myelomalacia is sometimes called syphilitic myelitis.) 

(4) Gummata of the cord — relatively infrequent. 

(5) Vascular disease. Softening is rare and involves small areas 
only. 

(6) Perineuritis gummosa of the sensory or motor nerve roots. 

Sarcomatosis. 

Multiple sarcomatosis of the brain and cord shows more steady pro- 
gression and greater constancy of symptoms than is usually observed in 
syphilis. 

In cerebrospinal syphilis, tabes, and dementia, lymphocytes are found 
increased in the cerebrospinal fluid, withdrawn by lumbar puncture. The 
presence of the spirochete pallida in the fluid makes the diagnosis of 
syphilis absolute. The Wassermann reaction is of very great value in the 
recognition of the syphilitic character of obscure cases. 

Albumosuria present in cerebrospinal meningitis, absent in tubercular 
meningitis. 

Acute meningitis should be differentiated from other affections of the 
meninges, etc., and from — 

Cerebritis, acute softening, intracranial tumor, ear disease, and head 
symptoms of continued fevers, acute rheumatism, acute ulcerative en- 
docarditis, pneumonia, pericarditis, tubercular meningitis, cerebrospinal 
meningitis, delirium tremens, acute mania. 

Cerebrospinal meningitis is differentiated by the more prominent dis- 
turbances of sensation, by herpes, and by the occurrence of other cases. 
Basilar meningitis occurs more especially in children affected with tuber- 
culosis elsewhere, or who come of tuberculous stock. It has long pro- 
dromes, and a longer duration. Its symptoms are less acute and intense. 
It more frequently implicates the membranes of the spinal cord. Pachy- 
meningitis is a disease of age. It occurs in drunkards, and in cases of 
dementia paralytica, chronic insanity, etc. It shows a more fluctuating 
course. It must be repeated again and again that the various forms of 
meningitis are to be separated and decognized more by the etiological 
relations of the disease than bby any difference of symptomatology. 

Tuberculosis and typhoid fever show typical temperature curves, with 
lung symptoms in tuberculosis, and abdominal symptoms in typhoid fever. 
In scarlatina, variola, and erysipelas it is rather a question of detecting 
a complication, as each disease shows characteristic eruptions upon the 
surface. Here, too, the persistence of cerebral signs after subsidence of 
the high temperature is of value. Septic and pyemic diseases follow wounds, 
are attended with chills, and show joint affections and internal metastases. 
Ulcerative endocarditis, a septic process, has the same history. Uremia 
is recognized by the dropsy, the condition of the urine, and, so far as the 
nervous symptoms are concerned, by the predominance of convulsions. 



y 



274 Diagnosis of Syphilis. 

ORGANS OF SPECIAL SENSE. 
Organs of Sight. 

Reference has already been made to the deep seated affec- 
tions of sight, such as cerebral disease and affection of the optic 
nerves. Here we will discuss only the affections of the eyes. 

All three stages have been observed in the eyebrows. The 
initial lesion is rare. 

The lids, also, may be affected in all stages of syphilis. Ini- 
tial scleroses and papules have been occasionally observed. In 
such cases there is ulceration, the surrounding skin is swollen, 
the conjunctiva is often chemotic, and there is swelling of the 
preauricular or submaxillary lymphatic glands, or of both 
groups. There is the characteristic induration, and an absence 
of the history of trauma. 

The second stage may be represented on the lids by macules, 
papules or pustules, as a part of the general eruption, especially 
in neglected or malignant cases. The papules are usually cov- 
ered with crusts. As a rule they are situated on the free border 
of the lid, and tend to ulcerate and cause loss of the eyelashes, 
madarosis. The loss of the eyelashes may occur also as an ex- 
pression of alopecia, independent of previous affection of the 
lids. 

The lids may be the seat of gummatous infiltrations and 
ulcerations, often associated with similar affection of the fore- 
head, temple, cheek and nose. Gummata may occur as hordeola 
and chalazion, or as flat superficial infiltrations, or as tumors, 
which may reach the size of an almond or of the normal eye 
or even larger. Often there is affection of the skin, and also 
of the cartilage, tarsitis syphilitica. Pain may be severe or 
absent altogether. Ulceration is common. The prognosis is 
better when the infiltrations do not go on to ulceration. But 
in either case there is often considerable subsequent deformity, 
because of the loss of substance and the subsequent contraction 
of the skin and cartilage. Destruction of the hair follicles may 
lead to a loss of the lashes. 



Diagnosis op Syphilis. 275 

In diagnosis we must differentiate between the rare cases 
of chancre and those of gummata of the lids, and also between 
the syphilitic and the non-syphilitic chalazion or hordeolum. 
There is usually not much difficulty differentiating syphilis of 
the lid from lupus, which usually first affects the cheek or nose. 
However, in exceptional cases lupus may be confined to the 
lids. At times it is necessary to differentiate between syphilitic 
and cancerous ulcer. 

Syphilis is one of the general causes of blepharitis. In 
suspicious cases, we must remember that there are many other 
general causes of blepharitis, e. g., tuberculosis, the exanthe- 
mata, anemia, and malnutrition from any cause. Among the 
important local causes are external irritation, such as may be 
caused by vitiated air or smoke; injuries, chronic conjunctivitis, 
inflammation of the lachry mo-nasal passages, disease of the 
rhino-pharynx, and possibly also abnormal shortness of the lids. 
At times a stubborn blepharitis depends upon eczema, eczema 
seborrhoeicum, seborrhoea, or acne. The oculists seem to stretch 
a point in declaring that blepharitis may be due to refractive 
errors. 

Dacryoadenitis, inflammation of the lachrymal gland, has 
at times been ascribed to syphilis. Among the other causes are 
traumatism, "catching cold," rheumatism, mumps, gout, sep- 
ticemia, and the extension of inflammations from the conjunctiva 
and cornea. 

Dacryocystitis, inflammation of the lachrymal sac, may occur 
as an extension of inflammation from chronic nasal affections 
in cases of inherited or acquired syphilis. Indeed, chronic nasal 
syphilis is especially liable to involve the lachrymal apparatus. 
Stricture of the nasal duct may be due to this cause. 

Conjunctiva. 

The chief syphilitic lesions are : 

1. Chancre. 5. Nodular syphilides. 

2. Papular syphilides. 6. Syphilitic ulcer, and 

3. Copper-colored spots. 7. Gummata. 

4. Mucous patches. 



276 Diagnosis op Syphilis. 

The search for the spirochete pallida and the Wassermann 
reaction may afford valuable aid in diagnosis. 

The conjunctiva may be affected in all stages of syphilis, 
though less often than the lids. The initial scleroses usually are 
found on the transition fold of the lower lid, rarely on the con- 
junctiva tarsi or the conjunctiva bulbi. The primary sore is 
frequently accompanied by conjunctivitis and photophobia. 
The preauricular and submaxillary lymphatics are the seat of 
indolent buboes. Recovery usually occurs without permanent 
injury, save possibly a scar. 

During the second stage of syphilis there is sometimes a 
stubborn conjunctivitis. A similar condition, marked by red- 
dening of the conjunctiva, is sometimes observed in hereditary 
syphilis. The conjunctiva may be the seat of slightly elevated 
papules during the second stage of syphilis, accompanying a 
similar eruption on the lids or over the body. 

Gummata of the conjunctiva generally involve also the 
sclera, and may extend to the limbus cornea;. When ulceration 
takes place, there is left a cicatrix or pterygium-like thickening 
of the conjunctiva. Gummata must be at times differentiated 
from carcinoma and sarcoma. Gumma of the caruncula; has 
also been mistaken for cancer, the differentiation being made by 
the therapeutic test . 

The tear ducts may be affected by syphilis of the conjunc- 
tiva or lids or of the mucous membrane of the nose. Dacryocys- 
titis may occur in either acquired or hereditary syphilis. Os- 
titis or periostitis of the bony lachrymal canal may affect the 
lachrymal sac and duct. 

Stricture of the nasal duct may be due to syphilis, either 
inherited or acquired. Thus, of two hundred cases of stricture 
of the nasal duct, in Galezowski's clinic, seventeen were of 
syphilitic origin. Other causes are nasal tuberculosis extend- 
ing to the lachrymal passages : polypi of the lachrymal sac : and 
occlusion resulting from rhinitis attending the exanthemata, 
especially measles, scarlet fever and smallpox. 



Diagnosis of Syphilis. 277 

Cornea. 

We have already referred to affection of the cornea in 
syphilis. Considerable diagnostic importance is attached to 
keratitis parenchymatosa as a symptom of syphilis. This may 
be present in acquired or in hereditary syphilis. This, to- 
gether with deafness and the changes in the incisors, consti- 
tutes the triad recognized by Hutchinson as characteristic of 
hereditary syphilis. 

Syphilitic keratitis, various known as interstitial or par- 
enchymatous keratitis, inherited, specific, and diffuse intersti- 
tial keratitis, is marked by the absence of destructive change 
in the cornea. The diagnosis is often aided by the presence of 
other symptoms or evidence of syphilis, such as the notched 
teeth described by Hutchinson. Deafness is less common. 

Parenchymatous keratitis is usually due to syphilis in pa- 
tients under thirty ; after that age it is more frequently due 
to other causes, notably rheumatism, gout and tuberculosis. A 
few cases have been reported in which the gummatous infiltra- 
tion extended to the cornea from the conjunctiva or sclera. 

Sclera. 

Gummata of the sclera are rare. Because of their rarety, 
they must be differentiated from malignant neoplasms. The 
Wassermann reaction and the therapeutic test suffice to make 
the differentiation. 

Iris. 

There are many causes of iritis. Thus, among the local 
causes are foreign bodies in the cornea, penetrating wounds 
of the eyeball, careless and continued use of caustic agents, and 
smollen masses of lens-matter. Inflammation may extend to the 
iris by continuity from the cornea, sclera, ciliary body, or 
choroid. Or iritis may be an expression of sympathetic oph- 
thalmitis, arising from trouble in the other eye. 



278 Diagnosis of Syphilis. 

Among the general causes of iritis, syphilis easily takes first 
place. Other causes of iritis, that must at times receive con- 
sideration in making a diagnosis, are rheumatism, tuberculosis, 
gonorrhoea, and trauma. Rarely cases are due to relapsing 
fever, typhoid fever, typhus, smallpox, septicemia, cerebro- 
spinal meningitis, malaria, and influenza. The irregularities 
of menstruation have at times been accused of playing a role 
in etiology, iritis catamenalis. So that syphilis is far from 
being the only cause of iritis. 

Iritis is a prominent symptom of syphilis, which causes over 
half the cases. Papules have been occasionally observed, iritis 
papulosa, especially on the edge of the cilia or the pupil. Syph- 
ilitic iritis heals, frequently with injury to sight through the 
formation of posterior synechia; or occlusion of the pupil. Re- 
lapses are frequent, and the disease often extends to other parts 
of the eye, especially the ciliary bodies and the choroid. Rarely 
there is the formation of a secondary glaucoma. 

During the third stage of syphilis, gummata may occur in 
the iris. 



Diagnosis op Syphilis. 279 

Syphilitic Iritis. 

Syphilitic iritis is generally plastic ; may be parenchymatous. 

Most frequent in second stage of syphilis. 

Syphilitic parenchymatous iritis often presents small nod- 
ules at the margin of the pupil or at the ciliary border of the 
iris ; later these disappear to leave atrophic areas. 

The recognition of the nodules aids in the diagnosis of 
syphilis, but often there are no nodules present in syphilitic 
iritis. 

The nodules vary in size, sometimes being so large as to 
fill the anterior chamber and even burst through the envelopes 
of the eye. 

Simple Iritis. 

Non-syphilitic iritis may be due to rheumatism, gonorrhoea, 
tuberculosis, traumatism. Less frequent causes are diabetes, 
typhoid fever, typhus, relapsing fever, smallpox, cerebrospinal 
meningitis, septicemia, influenza, and malaria. 

Inflammation of the ciliary body is usually secondary to 
affection of the iris, constituting an iridocyclitis. Gummata of 
the iris and ciliary body may extend to cause perforation and 
destruction of the eye. Inflammation of the iris may also extend 
to the choroid, as an iridochoroiditis. 

The choroid may also be inflamed without affection of the 
iris. Syphilis is a prominent cause of diffuse exudative choroid- 
itis and choroiditis centralis. Choroiditis becomes dangerous 
when it causes cloudiness of the crystalline lens, or when it in- 
volves the retina or optic nerve* 



280 Diagnosis of Syphilis. 

Retina. 

The retina often shows hyperemia or irritation in syphilis, 
during the second stage of the disease ; and grave retinitis, also, 
is not uncommon. The optic nerve is often hyperemic early in 
syphilis, during the second stage. Affection of the intracranial 
portion of the optic nerve, or gummata of the brain or meninges, 
may cause optic neuritis or neuroretinitis. Independent syph- 
ilitic optic neuritis or neuroretinitis is apparently more rare. 
A number of observers have reported affections of the retina 
due to disease of the retinal blood veseels. Amblyopia and 
amaurosis, either permanent or tempoi'ary, often occur in tlie 
course of syphilis in the absence of demonstrable lesions, so far 
as ophthalmoscopic examination goes. 

We do not know whether there is a primary syphilitic ret- 
initis. Some observers declare that all cases of syphilitic 
retinitis are due to an extension of inflammation from the 
choroid. However this may be, a serous inflammation of the 
retina often results from syphilis. In syphilitic retinitis, the 
inflammation shows a tendency to be circumscribed instead of 
general, described by Galezowski as retinitis with exudative 
6pots. These may be present when there is also considerable 
general edema of the retina. A positive diagnosis of syphilis 
can be made only in the presence of concomitant evidence of the 
disease. The ophthalmoscopic picture is that of simple serous 
retinitis, the edema of the retina causing it to appear as if 
seen through a mist. The patient complains of a gradually 
increasing mist before the eyes, without decided pain in the 
eyes, sometimes with photophobia. Photopsies and .scintillations 
are common and are regarded by some as important symptoms 
of syphilitic retinitis. Irregularities of the field of vision and 
scotomas are common. Syphilitic retinitis may occur in heredi- 
tarv syphilis or in congenital cases from six months to two 
years after infection. Usually there is involvement of both eyes. 

Syphilitic chorio-retinitis usually begins in the uvea and 
involves the retina later. The inflammation may begin simul- 
taneouslv in the retina and choroid. Like syphilitic retinitis, 



Diagnosis op Syphilis. 281 

this affection begins from six months to two years after the 
primary infection. 

The etiology of retinitis proliferans is not clear, but syph- 
ilis and traumatism are regarded as prominent factors in 
causation. 

Crystalline Lens. 

Cloudiness of the crystalline lens has been referred to in 
connection with choroiditis. An independent hyalitis syphilitica 
is regarded as a possibility. This opinion seems to be based 
upon reasoning rather than upon actual observation. Thus, 
cataract is caused by atheroma of the blood vessels, and syph- 
ilis is known to be a prominent cause of atheroma. However, 
the literature is remarkably free from instances of independent 
syphilis of the crystalline lens. Gumma has been reported to 
affect the lens secondarily. 

Gummata of the orbit occasionally perforate the skull. 

Vitreous. 

Opacities in the vitreous have been ascribed to syphilis, and 
also to a number of other conditions, such as general exhaus- 
tion from long-continued fevers, gout, constipation, anaemia, 
congestion of the liver, irregular menstruation, and the action 
of certain drugs, especially arsenic. Injuries, through causing 
choroidal hemorrhage, may also cause opacities of the vitreous. 

Optic Nerve. 

Optic neuritis may be due to intracranial tumor — neoplasma 
of the brain or meninges ; gummata, tubercle, cysts, abscesses, 
tumors- — that increase intracranial pressure. Possibly active 
inflammation is a factor in etiology. Some observers lay great 
stress upon this class of causes. Others attribute an important 
role to interstitial edema of the brain tissue extending through 
the optic nerve to the papilla. At any rate, optic neuritis is one 



282 Diagnosis of Syphilis. 

of the most important diagnostic points in the recognition of 
intracranial growths and inflammations. 

Optic neuritis has also been observed in a number of infec- 
tious diseases: Measles, typhoid fever, influenza, scarlet fever, 
smallpox, malaria, whooping-cough, beri-beri, pelagra, typhus, 
typhoid fever, pneumonia, rheumatism, diphtheria, myxedema, 
and acromegaly. 

In many of these cases the optic neuritis may have been due 
to nephritis, meningitis, or syphilis. 

Syphilis is one of many causes of optic neuritis. It may 
cause optic neuritis by attacking the nerve directly or by pro- 
ducing a gumma in the cranial cavity. Optic neuritis may be 
divided into (1) intraocular optic neuritis, papillitis, and (2) 
retrobulbar neuritis, characterized by inflammation of the nerve 
between the eye and the chiasm. 

Intraocular optic neuritis has been subdivided by v. Graefe 
into (a) choked disk, papillitis from stasis, and (b) simple 
optic neuritis, or descending optic neuritis, in which the inflam- 
mation spreads down the nerve trunk from an intracranial lesion. 

Choked disk causes disturbances of vision of varying degree 
up to complete blindness. There is generally a gradual reduc- 
tion of the central acuity of vision, sometimes with a central 
scotoma, more often with contraction of the field of vision at the 
periphery, frequently more marked at the nasal side. But the 
interference with the field of vision is subject to all sorts of 
variations. The color-sense may be little or greatly affected. 
The field of vision for the various colors do not always corre- 
spond. A pronounced choked disk is characterized ophthalmo- 
scopically bj T obliteration of the outlines of the papilla, its place 
being marked by an elevated mass marked on the surface by 
radiating stria? that fade gradually into the surrounding tissue. 
Near the center are the larger retinal vessels, the veins large 
and tortuous, the arteries often reduced in size. Rarely pulsation 
of the arteries may be noted. The capillary vessels on and 
close beneath the surface of the elevation are numerous and 
enlarged. On the borders of the elevated mass and in the sur- 
rounding retina small patches of whitish exudate and hemor- 



Diagnosis of Syphilis. 283 

rhages are not uncommon, and when large and numerous would 
indicate a neuro-retinitis. In such cases opacities may develop 
in the posterior portion of the vitreous, sometimes with newly 
formed blood vessels leading out to them. The height of the 
elevation may be an aid in diagnosis. Thus, in choked disk the 
height of the elevation measured with the ophthalmoscope va- 
ries from 1 D to 6 D. When less than this, the condition verges 
into that of simple papillitis. 

Simple papillitis, as stated, is marked by less elevation of 
the mass at the site of the papilla. There is also less complete 
obliteration of the borders of the papilli; the striae are not so 
prominent. However, hemorrhage and exudation may be even 
more extensive than in cases of pronounced choked disk. 

Usually it is easy to recognize an intraocular optic neuritis 
with the ophthalmoscope, when the media are clear. The con- 
dition must not be mistaken for hyaline bodies in the papilla 
nor an obscuration of the borders of the disk by opaque nerve 
fibres. Cases described as false or spurious optic neuritis have 
probably been due to the latter condition, the margin of the 
disk being more or less completely obscured by a grayish stria- 
tion, resembling a mild case of choked disk. Such cases show 
an absence of the other signs of stasis, that we would expect to 
find in choked disk, such as enlarged capillaries. 

Having made a diagnosis of choked disk, we must next con- 
sider the cause of the condition. The most frequent cause is an 
intracranial tumor. Indeed, choked disk is a prominent symp- 
tom of such tumors, some observers declaring that it occurs in 
95 per cent, of all cases. It is interesting to note that some 
observers declare that optic neuritis in these cases is not due to 
simple stasis, but is rather an active inflammation caused by 
the passage of irritating substances, produced directly or indi- 
rectly by the tumor. The other theory, supported by v. Graefe 
and many other prominent ophthalmologists, is that the con- 
dition depends upon the increased intracranial pressure caused 
by the tumor. Others have attributed choked disk to the exten- 
sion of an edema of the brain tissue through the optic nerve to 
the papilla ; or to the edema of the nerve trunk causing com- 



284 Diagnosis of Syphilis. 

pression of the central retinal vein. However, the presence 
of a double choked disk points strongly to the presence of an 
intracranial tumor. Exceptions have been noted. Thus, in a 
case reported by Krohn, metastases from a carcinoma of the 
ovary caused a double choked disk through the development of 
metastases in the optic nerve behind each globe. Unilateral 
choked disk may be due to brain tumor, which is explained by 
the pressure-theorists upon the ground of a localized meningitis 
or hemorrhage. 

All sorts of brain tumors may cause choked disk. Thus it 
has been observed in neoplasms of the brain, meninges or skull ; 
in gunimata, tubercles, cysts, abscesses, and aneurysms. 

Great diagnostic aid is often afforded by the Wassermann 
reaction. 

Optic neuritis may be caused by a great number of general 
diseases, besides the local causes, such as tumors or inflamma- 
tions in the cranial or orbital cavities, meningitis, infectious 
thrombosis of the brain sinuses, etc. Among such general causes 
are measles, typhoid fever, and influenza ; less frequently scar- 
latina, variola, malaria, whooping-cough, beri-beri, pelagra, 
typhus, pneumonia, rheumatism, diphtheria, and myxedema. 
Albuminuria may cause a neuritis, which may explain the oc- 
currence of that condition in so many of the general diseases. 
In other cases it may be due to infection of the trunk or inter- 
vaginal space of the nerve, or to a general toxemia. Other 
causes of optic neuritis are disorders of menstruation, especially 
those marked by a sudden stopping of the flow, and cases of 
premature menopause and atrophy of the uterus ; hydrocephalus 
internus ; deformities of the skull ("Thurmschadel") ; cerebral 
softening : puerperium : lactation : chlorosis ; severe hemorrhages ; 
gonorrhoea ;nephritis ; lead poisoning, either directly or through 
lead-nephritis : intranasal cauterization: acromegaly: sunstroke; 
violent physical exertion ; carious teeth, etc. At any rate, optic 
neuritis has been found in all these conditions. 

Retrobulbar neuritis may be divided clinically into (1) 
acute or fulminant retrobulbar neuritis, and (2) chronic retro- 
bulbar neuritis. 



Diagnosis op Syphilis. 285 

(1) Acute or fulminant retrobulbar neuritis is character- 
ized by pain back of the eye, that may be spontaneous, present 
upon movement of the eye or upon pressure upon the eyeball ; 
obscuration of vision, that progresses to complete or nearly 
complete blindness in from one to eight days. With these not 
infrequently there are associated the symptoms of acute myelitis, 
more rarely of multiple neuritis. The ophthalmoscope reveals a 
normal disk or a hyperemic nerve-head with or without slight 
haziness of the surrounding retina, and rarely minute retinal 
hemorrhages and small grayish or yellowish spots in the neigh- 
borhood of the macula. Syphilis can not be regarded as a prom- 
inent cause of this disease, the condition most frequently being 
referred to rheumatism and influenza. Other infectious diseases 
seem sometimes to play a role in etiology. 

(2) Chronic retrobulbar neuritis. In this class should be 
placed the cases of recurrent attacks of acute retrobulbar neu- 
ritis and also those that run a slow course, the loss of vision 
progressing for several months as a central scotoma, the loss 
of vision at first being only relative in that some or all colors 
are mistaken within its borders. The ophthalmoscope may 
reveal nothing abnormal, or there may be congestion of the 
disk and slight haziness of the surrounding retina. Later, in 
long continued cases, there is atrophy of the outer quadrant or 
half of the optic disk, and occasionally atrophy of the entire 
disk even where the defect of vision is limited to a central 
scotoma. Syphilis is not a prominent cause, the disease usually 
being due to rheumatism or exposure ; chronic meningitis or 
periostitis in the optic canal ; and most frequently the condition 
is a toxic amblyopia, due to systemic poisoning with alcohol, 
tobacco, lead, carbon disulphid, iodoform, quinin, mydriatic al- 
kaloids, male-fern, and ptomains; less frequently the salicylates 
and salicylic acid, cocain, snake venom, carbolic acid, aconite, 
chloral, santonin, picric acid, digitalis, tea, coffee, chocolate, 
gelsemium, ergot, the coal tar products, arsenic, naphthalin, 
potassium bromid, ergot, amyl nitrite, nitrobenzol, mercurial 
compounds, silver nitrate, antipyrin, curare, etc. 

UhthofF gives the following points of differentiation between 



286 Diagnosis of Syphilis. 

the toxic retrobulbar neuritis, such as is due to alcohol and 
tobacco, and the cases of retrobulbar neuritis due to syphilis, 
rheumatism, disorders of menstruation, cold, diabetes, etc.: (a) 
In true toxic amblyopia the central scotomata are almost in- 
variably confined to red and green, (b) The scotomata and 
visual disturbances are bilateral, and the former are confined to 
the center of the field, (c) Vision does not fall below 6/200. 
(d) The form of the scotoma is that of an oval, including both 
blind spot and fixation-point, with its long axis lying above 
the horizontal meridian, (e) The vision becomes gradually less, 
(f) The disease affects men above forty years of age. (g) 
Pain is noticed on extreme ocular movements in essential retro- 
bulbar neuritis, but is invariably absent in the toxic form. 

Atrophy of the optic nerve may be due to sclerotic changes 
following retinitis, or be associated with sclerotic changes in the 
spinal cord. Thus, atrophj 7 of the optic nerve is one of the 
early symptoms in some cases of tabes. Many cases are due 
to multiple sclerosis, exophthalmic goiter, cerebral syphilis, pro- 
gressive paralysis, syringomyelia, amyotrophic lateral sclerosis, 
degenerative changes, and various mental diseases. 

Ocular Muscles. 

Affections of the ocular muscles may be due to many causes. 
Thus, there may be over-development or under-development of 
the muscle itself, so-called structural squint or heterophoria ; 
or there may be faulty insertion of the tendon of the muscle, 
so-called insertional squint or heterophoria. Finally, there may 
be paresis or spasm of a muscle due to an affection of its nerve 
or nerve nucleus, so-called innervational anomalies, paretic and 
spastic squint or heterophoria. Syphilis, especially tertiary 
syphilis, plays a prominent role in the etiology of the cases due 
to paresis of muscle. Many cases are due to tabes. Other 
causes are meningitis, tuberculous meningitis, pachymeningitis, 
tumors of the brain and skull, abscess of the brain, hemorrhages 
in the brain, exposure to cold ("rheumatic" paralysis), trauma- 
tism, and hysteria. More rarely cases are due to diphtheria, 



Diagnosis op Syphilis. 287 

diabetes, influenza, whooping-cough, various poisons, and slight 
impairment is sometimes observed in neurasthenia. 

Among the causes of muscular spasm are irritative lesions, 
such as are caused by meningitis ; chorea, epilepsy, and hysteria. 
Spasm is less frequent than paresis. Sometimes the cause may 
not be apparent, when the cases are classed as idiopathic. The 
antagonist of a paralyzed muscle is prone to show spasm sooner 
or later. 

The symptoms of muscular over-action and under-action 
are: 

1. Limitation or excess of movement of affected eye in some 
direction. 

2. Diplopia. 

3. False projection of objects seen with the affected eye. 

4. Apparent movement of objects when patient approaches 
them. 

5. Vertigo. 

6. Altered position of head in attempt to overcome diplopia. 

7. Mydriasis and 

8. Paralysis of accommodation, in ophthalmoplegia interna. 

9. Ptosis (with 7 and 8) in complete oculomotor paralysis. 

Organs of Hearing. 

We have already referred to the central changes that may 
cause alterations in hearing, so that we will consider here chiefly 
the changes in the ears. 

The ears are rarely affected by chancre, though isolated 
cases of primary infection of the ears have been reported, the 
infection being carried by a towel, a bite, a kiss, or by the 
Eustachian catheter. 

The second, or irritative, stage of syphilis is represented on 
the external ear by macules, papules and pustules, as is true of 
the skin in general. Such affection of the ear usually indicates 
a neglected case. Exceptionally papules may occur in the 
external auditory canal in cases with only moderate develop- 
ment of syphilides over the body. Such papules may greatly 



288 Diagnosis op Syphilis. 

interfere with hearing when they obstruct the canal ; a wide 
canal is not so likely to be occluded. Papules may also occur 
upon the drum membrane ; in such cases roaring in the ear is a 
prominent symptom. Under proper treatment all of these cases 
usually result in recovery without loss of hearing. Ulcerative 
papules in the canal may lead to loss of the little hairs and the 
formation of flat or depressed cicatrices, but their course is 
usually favorable. 

Gummata of the external ear are comparatively rare, though 
gummatous ulcerations and gummatous infiltrations with subse- 
quent atrophy and contraction of the cartilages have been 
observed. A gummatous ulceration of the external canal that 
led to circular contraction, has been reported. 

Syphilis may involve the middle ear. usually in cases show- 
ing a syphilitic pharyngitis and rhinitis. Syphilides or gum- 
mata may occlude the Eustachian tube at the ostium pharyngeum, 
and subsequent cicatricial contraction often causes permanent 
loss of hearing. Otitis media may occur independently or 
through tubal transmission of the inflammation. The inflam- 
mation is often purulent, the membrana tympani becomes cloudy 
and possibly is perforated. During this process there is ring- 
ing in the ear. but often there is no special pain. There is 
lowered bone conduction in complicating diseases of the laby- 
rinth. Syphilis of the ear may lead to caries and necrosis of 
the tympanic cavity, the mastoid process and the petrous por- 
tion of the temporal bone. Such cases ma} - result fatally. 

Syphilis of the internal ear (the auditory nerve and the 
labyrinth) occurs during the first two years and sometimes 
later. In these cases deafness develops either suddenly or grad- 
ually, and as a rule is permanent. However, in some cases im- 
provement of the deafness occurs, though the improvement is 
usually only temporary. 

Affection of the labyrinth in syphilitics sometimes seems to 
follow "catching cold." There is diminution of bone conduc- 
tion, and there is lessened perception of the high tones. The 
hearing is suddenly destroyed permanently. Inflammation of 
the interna] ear causes noises in the ear, attacks of vertigo, and 



Diagnosis of Syphilis. 289 

disturbances of equilibrium. Though one ear seems most af- 
fected, the process usually involves both ears. 

All in all, affection of the labyrinth is rare compared with 
the frequency of syphilis. Most of the cases present catarrhal 
or purulent otitis that probably act as predisposing factors, 
though these, too, may be due to syphilis. 

Affection of the internal ear has been observed in hereditary 
syphilis from the eighth to the twentieth year, most frequently 
in the female (three to five times). Such cases usually show 
interstitial keratitis, though cases of keratitis are often observed 
that show no affection of the ear. Thus, of Hutchinson's one 
hundred and two cases of syphilitic keratitis, only fifteen showed 
deafness. 

In the disturbances of hearing due to basilar meningitis, 
there is usually also paresis of other cerebral nerves. Such 
cases may show hallucinations of hearing. In a case reported 
by Lang, there was a weak memory, diabetes insipidus, and a 
lowered hearing power on one side, sometimes amounting to 
absolute deafness, due to a nodular syphilide. 

In making a diagnosis of syphilis of the ear, it must be 
remembered that various parts of the ear may be affected by 
syphilis in the same individual. Thus, syphilis of the external 
ear may be associated with syphilis of the middle ear, and syph- 
ilis of the middle ear may complicate syphilis of the internal 
ear, and occasionally disturbance of hearing may be due to 
central affection. 

Organs of Smell. 

We have already referred to the alterations of the sense of 
smell due to central disease, especially basal meningitis. The 
sense of smell may be altered also through affection of the olfac- 
tory nerves. 

Rhinitis syphilitica also causes changes in the sense of smell. 
This has already been discussed. 



290 Diagnosis of Syphilis. 



Organs of Taste. 

There are many causes of alterations of taste. Syphilis of 
the tongue or palate may disturb especially the finer distinctions 
of taste. Intensely interesting, from a diagnostic standpoint, 
are those cases in which alterations of taste have apparently 
depended upon central disease. Syphilitic involvement of the 
glossopharyngeal or the fibres of the chorda ma} 7 affect the taste. 
Loss of taste has been observed in neuralgia of the third branch 
of the trigeminus twenty years after syphilitic infection, in 
which a cure was effected with iodide of potassium. 









Diagnosis op Syphilis. 291 

Conclusions. 

1. The diagnosis of syphilis is not always easy. 

2. There are numerous combinations of signs and symp- 
toms that are characteristic of syphilis. 

3. The therapeutic test for syphilis is not always reliable, 
(a) Other diseases sometimes respond to the use of anti-syphil- 
itic remedies in the absence of syphilis, (b) Some of the mani- 
festations of syphilis respond very slowly or not at all to the 
use of the anti-syphilitics. 

4. A syphilitic is not exempt from other diseases. 

5. Syphilis presents so many and such varied manifesta- 
tions that it is well to think of this disease when making a diag- 
nosis in obscure cases. 

6. We should not be unduly influenced by the social status 
of our patient. Syphilis and virtue are not incompatible. 

7. The old saying "once a syphilitic always a syphilitic," 
should not be taken too seriously. There is probably no chronic 
disease more genuinely amenable to treatment than syphilis. 
But the fact of its curability does not abrogate our dread of 
this most infamous disease. 

8. The spirochete pallida and the Wassermann reaction are 
positive evidences of syphilis. In this connection we must bear 
in mind that syphilitics do not enjoy any immunity from non- 
syphilitic affections. Furthermore, the spirochete pallida is 
often difficult to find, especially late in the course of syphilis. 
And the Wassermann reaction may be absent, especially when 
the patient has been subjected to vigorous anti-syphilitic treat- 
ment. 

9. Parasyphilis is a term that should never be used, at least 
in its old significance. Cases are either syphilitic or non- 
syphilitic. Later researches may possibly reveal a use of the 
term analogous to the use of paratyphoid in relation to true 
typhoid infection. But the old use of parasyphilis should be 
discontinued, since the recognition of the spirochete and the 
development of the serum reaction enable the diagnosis to be 
made with greater accuracy than formerly: 



RECENT BIBLIOGRAPHY BEARING ON THE 
DIAGNOSIS OF SYPHILIS. 



Aboulker, C. — Gommea syphilitiques 
de la langue et de la face, avee 
osteo-arthropathie specifique 
des deux genoux — Bull. med. 
de l'Algiere, Alger, 1905, xvi, 
371. 

Abt, I. A. — Congenital syphilis in 
infants — Interstate M. J., St. 
Louis, 1909, xvi, 259. 

Abt, I. A. — Congenital syphilis 
(Abstr) — Illinois M. J., Spring- 
field, 1909, xv, 405-406. 

Aeliard— Syphilis viscerale, avec 
ophtalmoplegie double — Bull, 
med., Paris, 1906, xx, 323-326. 

Adamson, H. G. — Inherited syphilis 
—Rep. Soc. Study Dis. Child, 
Lond., 1908, viii, 93-107. 

Adamson, H. G. — On eruptions of 
the napkin region in infants, 
with especial reference to the 
diagnosis of the eruptions of 
congenital syphilis from cer- 
tain non-specific napkin-area 
eruptions of common occur- 
rence^ — -Brit. J. Child. Dis., 
Lond., 1908, v, 13-24. 

Aitkin, C. J. H. — Late manifesta- 
tions of congenital syphilis — 
Transvaal, M. J., Johannesburg, 
1907-8, iii, 310. 

Albanns, G. A. — Fever following 
syphilis — Vrach., S. Petersb., 
1908, vii, 12-14. 

Albarel — Le testicule pathologique 
dans Rabelais — Chron. med., 
Paris, 1905, xii, 593. 

Alessandrello, G. — Sifilosclerosi in- 
iziale del labbro inferiors od 
epitelioma u 1 c e r a t o — Gior. 
med. d. r. esercito, Roma, 1907, 
lv, 511-515. 

Alezais — Lesions du colon dans la 
syphilis congenitale chez le 
nouveau-ne — Marseille med., 
1905, xlii, 414. 



Alglave, P. — Note sur un cas de 
syphilis gommeuse testiculaire 
avec volumineuse hydrocele — 
Bull, et mem. Soc. anat., Paris, 
1906, lxxxi, 536. 

Allen — Double chancre of the upper 
lip — J. Cutan. Dis. incl. Syph., 
N. Y., 1906, xxiv, 74-76. 

Allen, E. S. — Syphilis— Am. Pract. 
and News, Louisville, 1906, xl, 
343-357. 

Allen, H. B. — Prevalence of syphilis 
in hospital post-mortem prac- 
tice^ — Australas. M. Cong. Tr., 
Victoria, 1909, ii, 238-245. 

Allen, H. B. — Syphilis — Intercolon. 
M. J., Australas, Melbourne, 
1909, xiv, 113-119. 

Allende, I. — Un caso de sifilis a 
localization multiple sobre va- 
rios organos y serosas — Rev. 
Soc. Med. argent, Buenos 
Aires, 1907, xv, 137-143. 

De Almeida, Magalhaes R. — Nota 
sobre a presenea de treponema 
pallidum en un feto syphilitico 
— Rev. med-cirurg. de Brazil, 
Rio de Jan., 1907, xv, 51-66. 

De Almeida, Magalhaes R. — Nota 
sobre a presenea de treponema 
pallidum en un feto syphilitico 
— Brazil-med., Rio de Jan., 
1906, xx, 229-232. 

De Almeida, Magalhaes R. — Nota 
sobre a presenea de treponema 
pallidum en un feto syphilitico 
— Brazil-med., Rio de Jan., 
1906, xx, 300-302, 1 pi. 

De Amicis, F. — Sifilide maligna; 
sifilide ignorata; transmissione 
hereditaria — Gior. ital. d. mal. 
ven., Milano, 1906, xli, 52-55. 

Almkvist, J. o. Jundell, L— Till 
fragan om spirochsete pallida 
( Schaudinn-Boff mann ) o c h 
syfilis — Allm. sven. Lakartidin, 
Stockholm, 1905, ii, 394. 



294 



Recent Bibliography. 



Alonso, A. F. — Le herencia sifilitica 
ocular y sis estigmas rudimen- 
tarios — An. de oftal., Mexico, 
1907-8, x, 299-308. 

Alvares, C. F. — Un caso de syphilis 
terciari con espirochoetas de 
Schaudinn — Brazil med., Rio de 
Jan., 1906, xx, 350. 

Alvarez. W. C. — The spirochseta pal- 
lida ( treponema pallidum) in 
syphilis — J. Am. M. Ass., Chi- 
cago, 1906, xlvi, 1687. 

DeAmato, L. — Sulla febbre sifili- 
tica terziaria — Riforma med., 
Palermo, Napoli, 1906, xxii, 
253-2.")!!. 

Andrews. C. R. — The specific organ- 
isms of syphilis and a simple 
staining method for their de- 
tection — Tr. M. Ass. Georgia, 
Atlanta, 1906, 150-160. 

D'Andria, R. — Criteri per stabilire 
dall ' f same placentare se la 
morte del feto dipenda o no da 
sifilide— Policlin., Roma, 1906, 
xiii. Bez prat. 1409-1415. 

Angelis, P. — Chancre indure du cul- 
de-sac inferieur de la conjonc- 
tive chez un enfant de 5 ans — 
Clin, opht., Paris, 1908, xiv. 
287-289. 

Angle. E. .1. — Extragenital chancre; 
a preliminary report of twelve 
cases — Med. Era, St. Louis, 

1908, xvii, 131-135. 

Angle, E, J. — A report of twelve 
cases of extra-genital syphilis — 
West. M. Rev.. Omaha, 1908, 
xiii. 204-210. 

Anthony. H. C. — Syphilis of the 
male genito-ui inary organs — 
Illinois M. J.. Springfield, 1906. 
ix. -249-256. 

Antonelli, A. — Frequence et me- 
canisme pathogenique du stra- 
bisme chez les heredo-syph- 
ilitiques — Ann. d. mal ven., 
Paris, 1907. ii. 81-92. 

Antonelli et Bonnard — Stigmates 
oculaires et stigmates dentaires 
d'hercdo-syphilis: a forme com- 
plexe et rare — Ann. d. mal. 
ven., Paris, 1908, iii. 343-351, 
incl. 2 pi. 

Antonelli — Pathologie naso-lacry- 
male dans la syphilis heredi- 
taire — Arch, d'ophth., Paris, 

1909, xxiv, 599-608. 

Apert, E. — Syphilis pulmonaire chez 
une fillette de 13 ans; gomme 



volumineuse ramoille occupant 
tout le lobe inferieur du pou- 
mon droit et s'accompagnant de 
pleurisie sero-fibrineuse syphilis 
du rein et de la rate — Bull. 
Soc. de pediat.. Paris, 1905, vii, 
128-135. 

Apert — Heredosyphilis du poumon 
droit — Bull. Soc. de pediat de 
Paris, 1908, xi, 254-262. 

Apert E., Levy-Fraenkel et Menard — 
Tabes et paralysie generale ju- 
veniles par paralysie acquise 
tabes de la mere; tabes et 
paralysie generale du pere — 
Bull. Soc. de pediat., Paris, 
19(17, ix, 331-338. 

ApostololT, V. L. — Gangrenous syph- 
ilitic ulcer in a tubercular pa- 
tient — Kharkov M. J., 1906, i, 
131-1HS. 

Aianjo, G. — Chancre sifilitico de la 
una de origen professional — 
Rev. sanmil. v med. mil. espan., 
Madrid, 111117'. i. 234. 

Archer e Silva — Sobre a spirochete 
pallida dc Schaudinn in syph- 
ilis experimental — Med. con- 
temp., Lisb.. 1906, xxiv, 20. 

Ardin-Delteil — Coma syphilitique 
recidivant — Bull. med. de l'Al- 
gerie, Alger, 1908, xix, 649-652. 

Aristoff — Hard chancre of the right 
tonsil; diphtheroid and vario- 
loid course of syphilis — Med. 
pribav. k. morsk. sborniku, St. 
Petersb., 1905, 138-143. 

Arloing, F. — Ophthalmoreaction ft 
la tuberculine dans qualques cas 
de Byphilis — Bull. Soc. de med. 
d. hop. de Lyon, 1907. vi, 364- 
368. 

Arloing. F. — Ophthalmoreaction ft 
la tuberculine dans quelqueg cas 
de syphilis — Lyon med., 1908, 

ex.. 117-100. 

Armand-Delille. P. et Blechamnn — 
Volumineuse splenomegalie avec 
reaction lymphoide et anemie 
metaplastique chez un nour- 
risson probablement syphilitique 
— Ann. de med. et chir. inf., 
Paris. 1907, xi. 480. 

Armand-Delille. P. F. — Heredo- 
syphilis niungolisme et malfor- 
mation^ eardiaques congenitales 
ehez un nourrisons — Bull. Soc. 
de pediat. de Paris. 1908, x. 
144-148. 






Recent Bibliography. 



295 



Armand-Delille, P. F. — Heredo-syph- 
ilis monogisme et malforma- 
tions cardiaques congenitales 
chez un nourrisson — Ann. de 
med. et chir. inf., Paris, 1908, 
xii, 474-476. 

Armstrong, J. M. — The etiology of 
syphilis— St. Paul M. J., St. 
Paul, Minn., 1906, viii, 439-456. 

Arnheim, G. — Kulturversuche der 
spirochaeta pallida — Dermat. 
Centralbl., Leipz, 1909, xii, 290- 
294. 

Arning, E. — Farbung der spirochsete 
pallida — Deutsche med. Woch., 
Leipz. u. Berl., 1907, xxxiii, 
1027. 

Arning, E. u. Klein, C. — Die prak- 
tische durchfiihrung des naeh- 
weises der spirochaeta pallida 
im grossen krankenhausbetrieb 
— Deutsche med. Wchnschr., 
Leipz. u. Berl., 1907, 1482-1487. 

Aronstan, N. E. — The diagnosis of 
syphilis — Centr. States M. 
Monit., Indianap., 1905, viii, 
257. 

Aronstan, !N. E. — A contribution to 
the study of the prognosis of 
syphilis — Am. J. Dermat and 
Genito-Urin. Dis., St. Louis, 
1905, ix, 51. 

Arthur, R. — The mimicry of syphilis 
— Australas. M. Gaz., Sydney, 

1908, xxvii, 132. 
Arquellada. A. M. — Estudio de la 

heredo-sifilis del rechen nacido 
y de las formas hereditaris 
precoz y tardia — An. de la 
Acad, de obst., Madrid, 1909, ii, 
350-364. 

Arquellada, A. M. — Estudio de la 
heredosifilis del recien nacido y 
de las formas hereditaria pre- 
coz y tardia — Rev. espan. de 
dermat. y sif., 1909, xi, 336-351. 

Arruga, H. — El problema de la 
sifilis — Gae. med. catal., Barcel., 

1909, xxxv, 201, 245. 
Ashhurst, A. P. C. — A case of syph- 
ilitic dactylitis of the toe — J. 
Am. M. Ass., Chicago, 1906, 
xlvi, 584. 

Ashi, K. — A rare case of hereditary 
syphilis — Hifukwa kin Hinjo- 
k'ikwa Zasshi, Tokyo, 1907, vii, 
450-452. 

Ashmead, A. S. — Relation of syph- 
ilis with Japanese racial pecu- 
liarities and customs — Am. J. 



Dermat. and Genito-Urin. Dis., 
St. Louis, 1906, x, 279-285. 

Ashmead, A. S. — Syphilis in rela- 
tion to crime — J. Cutan. Dis. 
incl. Syph., N. Y., 1906, xxiv, 
571. 

Ashmead, A. S. — On the supposi- 
tious relationship of crime 
with syphilis — Am. J. Dermat. 
and Genito-Urin. Dis., St. 
Louis, 1908, xii, 384-387. 

Ashmead, A. S. — Some observations 
on certain pathological ques- 
tions concerning the mutilation 
represented on the anthropo- 
morphous Huacos pottery of old 
Peru— N. York M. J., 1909, xe, 
857-861. 

Ashmead, A. S. — The question of a 
relationship between "syphili- 
tic" llamas of the department 
of Puno, Peru, and pre-Colum- 
bian syphilis in man — Am. 
Med., Burlington, Vt., and N. 
Y., 1909, ns. iv, 35-37. 

Ashmead, A. S. — Pre-historic syphi- 
lis in America — Med. Fort- 
nightlv, St. Louis, 1909, xxxvi, 
347-354. 

Ashmead, A. S. — On the question 
whether pre-Columbian syphilis 
in America originated by unnat- 
ural practices with female 
llamas — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1909, xiii, 453-460.. 

D'Astros — Oedeme et nephrite dans 
la syphilis hereditaire — Mar- 
seille med., 1908, xlv, 129-131; 
Discussion 149. 

Audrain — Sur un cas de leucome 
l'anodermie cervicale chez un 
heredo-syphilitique — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1908, xix, 8. 

Audry, C. — Deux cas de gangrene 
cutaneo-conjonctive d'origine 
syphilitique ( sclero-gomme 

sphaeelante) — Bull. Soc. franc, 
de dermat. et syph., Paris, 
1905. xvi, 160. 

Audry, C. — Deux cas de gangrene 
cutaneo-conjonctive d'origine 
syphilitique ( sclero-gomme- 

sphacelante) — -J. d, mal. cutan. 
et syph., Paris, 1905, xvii, 408. 

Audry, C. — Phlebite syphilitique 
ilio-crurale double — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1906, xvii, 347. 



296 



Recent Bibliography. 



Audry, C. — Essai sur la inortalite 
de la svphilis aequise — Seruaine 
med., Paris, 1907, xxvii, 301. 

Audry et Boyreau — Cyanose dou- 
loureuse intermittente d'un 
gros orteil d'origine syphilit- 
ique — Bull. Soc. franc de der- 
mat. et syph., Paris, 1906, xvii, 
392-394. 

Audry. C. — De la syphilomanie et 
de la syphilophobie — Ann. de 
dermat. et syph., Paris, 1908, 
4 s. ix, 129-140. 

Austin. M. A. — Syphilitic crises 
simulating surgical emergen- 
cies — Lancet-Clinic, Cincin., 
1908, c, 508-510. 

Austin, M. A. — A study of syphilitic 
crises — Am. J. Clin. M., Chi- 
cago, 1909. xvi. 657-659. 



Bab, H. — Spirochaetenbefunde im 
menschlichen auge; ein beitrag 
zur Genese der augenerkriinkun- 
gen bei hereditarer lues — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906. xxxii. 1945. 

Bab. H. — Beitrag zur bakteriologie 
der kongenitalen syphilis — 
Munchen med. Woch., 1907, liv, 
2265-2267. 

Bab. H. — Nerv oder mikroorganis- 
mus? — Munchen med. Woch., 
1907, liv, 315. 

Bab. H. — Bakteriologie und Biolo- 
gie der Kongenitalen Syphilis 
— Ztschr. f. Geburtsh. u. Gv- 
nak., Stuttg., 1907, lx. 161-21*1. 

Bab, H. — Das problem der luesueber- 
tragung auf das kind und die 
latente lues der frau im lichte 
der modernen syphilisforschung 
— Zentralbl. f. Gvnakol., Leipz., 
1909, xxxiii, 527-539. 

Bab, H. — Die luetische infektion in 
der sehwangershaft und ihre 
bedeutung fur das verebungs- 
problem der svphilis — Centralbl. 
f. Bakteriol.."l Abt, Jena, 1909, 
li, Orig. 250-275. 

Babes. V., u. Panea, J. — Ueber 
spirochaete pallida bei congeni- 
taler syphilis; nachtrag zu 
unserer mitteilung in No. 28 d. 
Wchnschr — Berl. klin. Woch., ] 
1905, xlii, 1506. | 



Babes, V., u. Panea, J.- — Ueber 
pathologische veranderungen 
und spirochaete pallida bei con- 
genitaler syphilis — Berl. klin. 
Woch., 1905*, xlii, 865. 

Babes, V., u. Mironescu, T. — Ueber 
syphilome innerer organe neu- 
geborener und ihre beziehungen 
zur spirochaete pallida — Berl. 
klin. Woch., 1906, xliii, 1119- 
1123. 

Babonneix, L. — Sur deux cas 
d'heredosyphilis precose (Rap- 
port par Nobecourt) — Bull. 
soc. de pediat., Paris, 1909, xi, 
95-89. 

Babonneix, L. et Voisiu, R. — Heredo- 
syphilis tardive chez deux sieurs 
— Gaz. d. hop., Paris, 1909, 
lxxxii, 1006. 

Badun. K. — Influenza es latens 
lues — Orvosi hetil, Budapest, 
1908, Hi, 429. 

Baetzner — L'imjwrtanza della rea- 
zione del siero di Wassermann 
per 1 a diagnosi della sifilide 
chirurgica — Gazz. internaz. di 
med., Napoli, 1909, xii, 259-261. 

Baetzner. W. — Die bedeutung der 
Wassermannschen serum-reak- 
tion fiir die differential-diag- 
nose der chirurgischen syphilis 
— Mflnchen med. Woch., 1909, 
hi. 330-334. 

Baginsky, A. — Die pathologie der 
parasvphilis im kindersalter — 
Arch.'f. Kinderh., Stuttg., 1909, 
liii, 133-150. 

Bain. J. — Inherited svphilis — Brit. 
M. J.. Lond., 1908, i, 683. 

Baisch, K. — Die vererbung der 
syphilis auf grund serologis- 
cher und bakteriologischer 
untersuchungen — MUunchen 
med. Woch., 1909, lvi, 1929- 
1933. 

Baldwin. A. — Note on a case of pri- 
mary chancre in the nostril — 
Lancet. Lond., 1907, i, 287. 

Ballenger, E. G. — The spirochaete 
pallida or treponema pallidum 
— Am. J. Dermat. and Genito- 
Urin. Dis., St. Louis, 1906, x, 
137-143. 

Ballenger. E. G. — A new method of 
staining motile organisms, 
renal tube casts and fixed 
smears of spirochseta pallida — 
J. Am. M. Ass., Chicago, 1909, 
liii, 1635. 



Recent Bibliography. 



297 



a;er, E. G. — Doea syphilis 
spontaneously abort ?— Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1907, xi, 413. 

Ballet, G., et Valensi, L. — Crises epi- 
leptiformes signe d'Argyl lymph- 
oeytose syphilis remontant a 42 
— Rev. neurol., Paris, 1907, xv, 
1213. 

Ballner, F., u. von Decastello, A. — 
Ueber die klinische verwertbar- 
keit der komplementbindungs- 
reaktion fur die serodiagnostik 
der syphilis — Deutsche med. 
Woch., Leipz. u. Berl., 1908, 
xxxiv, 1923-1927. 

Balzer et Deshayes. — Syphilides 
tertiaires avec elephantiasis des 
organes genitaux et glossite 
hypertrophique — Bull. Soc. 
frauc. de dermat. et syph., 
Paris, 1906, xvii, 115-117. 

Balzer et Deshayes. — Contribution 
a l'etude des syphilides atrophi- 
antes — Bull. Soc. franc, de 
dermat. et syph., Paris. 1906, 
xvii, 152-155. 

Balzer et Francois-Dainiville. — 
Chancre simple de la levre chez 
une ancienne syphilitique chan- 
cres simples vulvaires multiples 

Bull. Soc. franc, de dermat, 

et syph., Paris, 1905, xvi, 55. 

Balzer et Galuf. — Syphilide tu- 
berculeuse zoiforme avee cica- 
trices atrophique — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 360-362. 

Balzer et Galuf. — Adenopathie 
double preaurieulaire et suph- 
ilo-strumeuse au debut de la 
periode secondaire de la syph- 
ilis — Bull. ,Soc. franc, de der- 
mat. et syph., Paris, 1908, xix, 
152-154. 

Balzer et Merle, P. — Chancre 
tardif ou syphilide diphteroide 
de la levre inferieure — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1907, xviii, 231. 

Balzer et Poisot. — Syphilides 
corymbiformes avec erytheme 
peripapuleux — Bull. Soc. franc, 
de dermat. et syph., Paris, 
1906, xvii, 443. 

Balzer, Boye et Condouro — Chancre 
syphilitique de la paupiere 
superieure — Bull. Soc. franc, de 
dermat. et syph., Paris, 1908, 
xix, 339-341. ' 



Balzer, R., et Sevestre. — Gomme 
syphilitique du voile du palais 
apparus 50 ans apres le chan- 
cre — Bull. soc. franc. de 
dermat. et syph., Paris, 1909, 
xx, 134. 

Balzer, R., et Sevestre. — Gomme 
sporotrichosiques disseminees 
et ulcerees — Bull. soc. franc, 
de dermat. et syph., Paris, 
1909, xx, 185. 

Bandi, I. e Simonelli, F. — Sulla 
presenza dello spirochete pal- 
lida nel sangue e nelle mani- 
festazioni secondarie dei sifi- 
litici — Atti. d. r. Accad. d. 
fisiocrit. in Siena, 1905, 4 s. 
xvii. 539-545. 

Bandi, I. e Simonelli, F. — Sulla 
presenza dello spirochete pal- 
lido nel sangue e nelle niani- 
festazioni secondarie dei sifi- 
litici — Riforma med. Palermo- 
Napoli, 1905, xxi, 791. 

Bandi, I. e Simonelli, F. — Sulla 
presenza dello spirochete pal- 
lido nel sangue e nelle mani- 
festazioni secondarie dei sifi- 
litici — Gazz. d. osp., Milano, 
1905, xxvi, 884. 

Bandi, I. u. Simonelli, F. — Ueber 
das vorhandensein der spiro- 
chete pallida im blute und in 
den sekundaren erscheinungen 
der syphilis-kranken vorlaufige 
mitteilung — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1905-6, 
xl, 64. 

Bandi, I. u. Simonelli, F. — Ueber 
die anwesenheit der spirochete 
pallida in sekundarsyyphilit- 
ischen manifestationen und 
ueber die zu ihrem nachweis 
angewenden farbimgsmethoden 
— Munchen med. Woch., 1905, 
Hi, 1668. 

Bandi, I. e Simonelli, F. — Par- 
assitismo eellulare nella sifi- 
lide — Gazz. osp., Milano, 1906, 
xxvii, 595. 

Bandi, I. e Simonelli, F.— Zell- 
enparasitismus in der syphilis 
— Centralbl. f. Bakteriol. 1 
Abt., Jena, 1906, xli, 523-526. 

Bandi er, V. — Ueber spirochaetenbe- 
funde bei syphilis — Prag. med. 
Woch., 1905, xxx, 475. 

Bar — Preservation des norrices et 
des nourrissons centre la syph- 
ilis — 'Soc. franc, de prophyl. 



298 



Recent Bibliography. 



san. et mor. Bull., Paris, 1905, 
tome v, 256-271. 

Ear, P. et de Kervily, M. — 
Abundance des spirochetes 
dans les visceres de foetus 
syphilitiques morts et maceres — 
Bull. Soc. d'obst. de Paris, 
1907, x, 60. 

Bar, P. et Daunay, R.— Re- 
cherches sur le aero-diagnostic 
de la syphilis chez la femme 
enciente et l'enfant nouveau-ne 
( methode de Wassermann ) — 
Obstetrique, Paris, 1909, ns. 
ii, 192-260. 

Barbe et Levy-Valensi — Lacunes de 
desintegration cellulaire dans 
un systeme nerveux d'heredo- 
syphilitique — Rev. neurol., 
Paris, 1908, xvi, 339. 

Bareia. Caballero J. — Sifilisf Rev. 
espec. med., Madrid, 1905, viii, 
361. 

Barck, C. — The ocular manifests 
tions of syphilis — J. Missouri 
M. Ass., St. Louis. 1905-6, ii, 
656-667. 

Barduzzi, 1). — Di un easo di sifi- 
lide terziaria ignorata — Atti. 
d. r. Aecad. d. fisiocrit. in 
Siena, 1905, 4 s. xvii, 605-607. 

Barduzzi. D. e Simonelli, F. — 
Stato attuale della patogenesi 
della sifilide — Gior. ital. d. 
mal ven., Milano, 1906, \li. 
515-524. 

Barker, L. F. — Intention tremor in 
a case of tertiary syphilis — 
Johns Hopkins Hosp. Bull., 
Bait.. 1906. xvii. 160. 

Banuukoff, J. — Zur technik der 
versilberung von spirochete 
pallida i Schaudinn-Hofi'man ) — 
Centralbl. f. Bakteriol.. 1 Abt., 
Jena, 1909. 1, Orig., 263-267. 

Baron. L. — Der eiweissgehalt und 
die lymphozytose des liquor 
cerebrospinalis bei sauglingen 
mit lues congenita — Tarb. f. 
Kinderh., Berl., 1909. 3 F. six, 
25-63. 

Baronoff, J. P. — Gumma of the 
penis — Med. Press & fire, 
Lond., 1906, ns. lxxxii. 414. 

Barrett, J. B.— Case of syphilitic 
synovitis — Brit. J. Child. Dis., 
Lond., 1909, vi. 102-104. 

Bartel, J. — TJeber lymphdrusenbe- 
funde bei kongenitaler lues — 
Wien klin. Woch., 1908, xxi, 
721-724. 



Barthelemy, T. — Syphilis tertiaire 
verte du vrai microbe de la 
syphilis — Syphilis, Paris, 1905, 
iii, 401-417. 

Barthelemy, T. — Syphilis tertiaire 
acquise on hereditaire des or- 
ganes genitaux internes de la 
Femme — Syphilis, Paris, 1905, 
tome iii, '685-704. 

Barthelemy, T. — Syphilis tertiare 
acquise ou hereditaire des or- 
ganes genitaux de la femme — 
Syphilis. Paris. 1905, iii, 756- 
778. 

Barthelemy. ']'. — Arterite cerebrale 
tertiairs gensrshosi — Syphilis 
Paris, 1906. iv., 125-129. 

Baskin. J. L. — Haemo-pericardium 
associated with syphilis — Lan- 
cet. Lond., 1908, i, 424. 

Rassett-Smitli. P. YV. — Aneurysm 
of the heart due to syphilitic 
gummata — Brit. M. J., Lond., 
L908, ii. 1060. 

Bassett-Smith, P. W. — The diagnosis 
of syphilis by Bome Laboratory 
methods— Brit. M. J., Lond'.. 
1909, ii. 377-380. 

Batroff, W. C. — The spirocha?ta pal- 
lida—Med. Bull., Phila., 1906, 
xwiii, 206, 1 pi. 

BatrolT, W. C. — The spirochete 
pallida — Month. Cvel. and M. 
Bull.. Phila., 1909, ii, ' 103- 
108. 

Batut. — i hancre mou accidentel de 
la main, complications insol- 
ites — J. d. mal cutan. et syph., 
Paris, 1905, xvii, 241-258. 

Batut, L. — Du chancre de l'amyg- 
dale — J. (1. mal cutan. et svph., 
Paris. 1906. xviii, 321-339". 

Batut. L. — Syphilides zoniformes 
du thorax — J. d. mal. cutan. 
et syph.. Paris. 190S. xix. 412. 

Batut) L. — Syphilis secondaire mas- 
toidite et paralysie du facial — 
J. d. mal. cutan. et syph., 
Paris. 1903. xix, 413-415.' 

Batut, L. — Syphilides zoniformes 
du thorax — Bull. Soc. med- 
chir. de la Drome, Valence. 
1908, ix. 73. 

Batut. L. — Syphilis secondaire ma6- 
toidite et paralyse du facial 
gauche — Bull. Soc. med-chir. 
de la Drome, Valence, 1908, 
i\. 75. 

Batut, L. — Adenites bacillaires et 
syphilitiques — Bull. soc. med- 



Recent Bibliography. 



299 



chir. de la Drome, Valence, 
1909, x, 80-96. 
Baudouin, M. — La syphilis en 
Vendee — France med., Paris, 

1908, lv, 138-140. 

Bauer, A. — Nasenbluten eines syphi- 
litischen neugeborenen — Allg. 
med. Ztg., Berl., 1909, lxxviiii, 
45. 

Bauer, J.— Simplification de la 
technique du serodiagnostie de 
la syphilis — Seniaine med., 
Paris, 1908, xxviii, 429. 

Bauer, J. — Ueber die bei der Was- 
sermannschen luesreaktion wirk- 
samen korper and ueber die 
haemolytischen eigenschaften 
der organextrakte — Bioehem. 
Ztsehr., Berl., 1908, x. 301-313. 

Bauer, J. — Zur methodik des sero- 
logischen luesnachweises — 

Deutsche med. Woch., Leipz. u. 
Berl., 1908, xxxiv, 698. 

Bauer, J. — Zum wesen der Was- 
sermannschen luesreaktion — 
Berl. klin. Woch., 1908, xlv. 
834. 

Bauer, J. — Zur technischen vervoll- 
kommung des serologisehen 
luesnachweises — -Deutsche med. 
Woch., Leipz. u. Berl., 1909, 
432-434. 

Baxter, C. T. — Some notes on the 
history of syphilis — Middlesex 
Hosp. J., Lond., 1905, ix, 241- 
249. 

Bayet, A. et Renaux, E. — Le sero- 
diagostic de la syphilis (theorie 
et valeur pratique de la 
methode) — J. de med., Brux., 

1909, xiv, 98. 

Bayet — Nouvelles recherches sur le 

spirochsete pallida dans la 

syphilis — Policlin. Brux., 1905, 

xiv, 235. 
Bayet. — Le spirochete de la syphilis 

— J. med. de Brux., 1905, tome 

x, 385. 
Bayet. — Le Spirille de la syphilis 

etat de la question — Soc. roy. 

d. so. med. et nat. de Brux. 

Bull., 1905, Ixiii, 150. 
Bayet et Jacque — Le spirochete 

pallida Schaudinn — Rev. Prat. 

d. mal. cutan., Paris, 1905, iv, 

263-296. 
Bayet. — Reflexions sur 2250 cas de 

syphilis observes a Bruxelles — 

Soc. roy. d. sc. med. et nat. de 

Brux. Bull., 1906, lxiv, 323- 

334. 



Bayet. — Observations sur 2250 cas 
de syphilis observes a Brux- 
elles (contribution a l'etude 
des conditions sociales de la 
syphilis — J. med. de Brux., 
1907, xii, 1-7. 

Bayet. — Observations sur 2250 cas 
de syphilis observes a Brux- 
elles — Presse med. beige, Brux., 

1907, lix, 368. 

Bayly, H. M. — The use of the ultra- 
microscope for the early diag- 
nosis of syphilis — Lancet. Lond., 
1909, ii, "782. 

Bayly, H. W. — The serum diagnosis 
of syphilis; an analysis of 200 
consecutive sera examined for 
the Wassermann reaction in 
which a modified Neisser's tech- 
nique was used — Lancet, Lond., 

1908, i, 1523-1525. 

Bayon, H. — On extra-genital syph- 
ilis—Brit. M. J. Lond., 1908, 
i, 682. 

Bazzicalupo, G. — Sulla etiologia 
della sifilide (a proposito) dello 
spirochete di Schaudinn — Gazz. 
internaz. di med., Napoli, 1905, 
viii, 422. 

Bazzicalupo, G. — Manifestazioni an- 
atomische e cliniche della 
eredo-sifilide — Gazz. internaz. 
di med., Napoli, 1906, ix, 792- 
794. 

Beal, R. — Vaste ulceration de la 
region fronto-naso-palpebrale 
de nature epitheliale chez une 
syphilitique avec ouverture des 
sinus frontaux — Bull, de la- 
ryngol., otol. et rhinol., Paris, 
1906, ix, 63-69. 

Beall, P. T. B.— Syphilitic disease 
of the knee with cerebral 
symptoms — Med. Press and Circ. 
Lond., 1906, ns. lxxxii, 144. 

Beatty, H. A. — The etiology of 
syphilis — Canada Lancet, To- 
ronto, 1905, 6, xxxix, 576-582. 

Beaussart, P. — Sero-diagnostique de 
la syphilis "reaction de Wasser- 
mann" — Arch, de neurol., Paris, 

1909, ii, 177-209. 

Beck, S. — Researches on the spiro- 
chsete pallida occurring in 
hereditary syphilis — Gyerme- 
korvos, Budapest, 1905, 37. 

Beckers, J. K. — Zur serodiagnostik 
der syphilis — Muenchen med. 
Woch., 1909. Ivi, 551. 

Beer, A. — Ueber beobachtungen an 
der lebenden spirochaeta pal- 



300 



Recent Bibliography. 



lida — Deutsche med. Woch.. 
Leipz. u. Berl., 1906, xxxii, 
1192. 

Beer, A. — Ueber die neuen fort- 
schritte der syphilislehre — 
Deutsche Aerzte-Ztg., Berl., 
1906, 25. 

Beer, A. — Ueber den Wert der 
Dunkelfeldbeleuchtung fiir die 
klinische diagnose der syphilis — 
Muenchen med. Wchsehr.. 1907, 
liv, 1926-1929. 

Behaegel. — Chancre infectant de la 
levre — Policlin., Brux., 1905, 
xiv, 77. 

Behaegel — Syphilis maligne — Poli- 
clin., Brux., 1905, xiv, 101. 

Behaegel. — Da syphilis experimen- 
tal — Presse med. beige, Brux.. 
1906. lviii. 1090-1098. 

Behaeeel — La syphilis experimen- 
tale — Policlin.. Brux.. 1906. xv. 
321-330. 

Von Behm. — Ein fall von syphilis 
hereditaria tarda bei der ohr- 
labvrinthe — Arch. f. Ohrenh., 
Leipz.. 1905-6. lxvi. 74. 

Beitzke, H. — LTeber spirochete pal- 
lida bei angeborener syphilis — 
Berl. Id in. ' YVoch., 1906, xliii, 
781-784. 

Beitzke. H. — Zur kritik der silber- 
spirochate — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1906-7, 
xliii, 369. 

Bela, L. — Ein fall von multiplen 
muskelgumma — Pest med-chir. 
Presse. Budapest, 190S. xliv, 
974. 

Belcher, C. — Industrial syphilis — 
Brit. 51. J.. Lond.. 1009, i. 151. 

Belknap, J. L. — Syphilis sontium 
— Pep. Surg. Gen. Navy, 
Wash., 1904-5, 193. 

Bellezza, L. — Un caso di siflloma 
successivo (contributo ad una 
interessante e eontroversa ques- 
tione di sifilografia ) — Tribuna 
med., Milano, 1905, xi.. 193- 
205. 

Bellezza. L. — A proposito di uno 
caso di sifilomi successivi — Tri- 
buna med., Milano, 1906, xii. 
65-67. 

Bellezza, L. — L T n caso di fageden- 
ismo terziario — Tribuna san., 
Milano, 1907, i. 6-15. 

Benda, C. — Zur Levaditifarbung der 
spirocheta pallida — Berl. klin. 
Woch., 1907, xliv, 428; 480. 



Benda, C. u. Saling. — Discussion 
zur kritik der Levaditi'schen 
silberfarbung von mikroorgan- 
ismen— Berl. klin. Woch., 1907, 
xliv, 255. 

Beneke. R. — Zur Wassermann'schen 
syphilisreaktion — Berl. klin. 

Woch., 1908, xiv, 730. 

Benigni. D. F. — A proposito di un 
nuovo metodo por la siero- 
diagnosi nella sifllide — Riv. di. 
patol. nerv., Firenze, 1908, xiii, 
452-457. 

Benitez, F. C. — Sobre la spiroqueta 
pallida — Rev. med. cubana, Ha- 
bana, 1908, xiii, 149-152. 

Bonnie. P. B. — The frequency and 
intensity of congenital syphil- 
itic infection in children — In- 
tercolon. M. J., Anstralas, Mel- 
bourne, 1909, xiv, 119-129. 

Benola, F. — Sulla reazinne croma- 
tica de Schurmami par la siero- 
diagnosi della sifllide — Ri- 
forma med., Napoli, 1909, xxv, 
682. 

Berard. — Squirrheatrophique de la 
langue par degenerescence de 
leucoplasie chez un syphilitique 
—Lyon med.. 1906, cvii, 111- 
114. 

Berezovsky, E. and Entz, B. — Death 
from hemorrhage in conse- 
quence of syphilitic erosion of 
the right internal carotid — 
Budapesti orv. ujsag., 1908, vi, 
707-709. 

Berger. F. R. M. — Zur kenntnis der 
spirochaete pallid a — Dermat. 
Ztschr., Berl., 1906, xiii, 401- 
409, 2 pi. 

Berger, F. R. M. — Zur farbung 
der spirochete pallida — 
Muenchen med. Wchnschr., 
1906, liii, 862. 

Berger, F. R. M. — Zur farbung der 
spirochete pallida — Mtinchen 
med. Woch., 1906, liii, 1209. 

Bergh, R. — The relation of the 
lymphatic system to primary 
syphilitic infection in women — 
Hosp. Tid., Kobenh., 1905, 4 
R. xiii, 1161-1168. 

Von Bergmann — Ein irregularer 
blutbefund bei ostitis syphilit- 
ica— Berl. klin. Woch., 1908, 
xiv, 330. 

Beriel et Favre — Le treponeme de 
Schaudinn et les lesions pulmo- 



Recent Bibliography. 



301 



naires des nouveau-nes — Lyon 
med., 1906, cvii, 831. 

Bering, F. — Die praktische bedeut- 
ung der serodiagnostik bei 
Lues — Mfinchen med. Wchschr., 
1908, Iv, 2476-2479. 

Bernard, L. et Lortat et Salo- 
mon. — Syphilis osseuse multi- 
ple necrosante avee amyotro- 
phie et cachezie — Bull, et mem. 
Soe. med. d. hop., Paris, 1905, 
3 s xxii, 533-544. 

Bernhardt, R. — Spirochete pallida 
Sehaudinn im syphilitisehen ge- 
webe vorliiufige mitteilung — 
Allg. med. Centr.-Ztg., Berl., 
1906, lxxxv, 405. 

Bernhardt, B. — -Spirochete pallida 
Sehaudinn in tissues — Gaz. lek., 
Warszawa, 1906, 2 s., xxvi, 
289-291. 

Bertarelli, E. u. Volpino, G. u. 
Bovero, B. — Untersuehungen 
ueber die spirochete pallida 
Schaudimi bei spirochete pal- 
lida Sehaudinn bei syphilis — 
Centralbl. f. Bakteriol., 1 Abt., 
Jena, 1905-6, xl, 56-64. 

Bertarelli, E. u. Volpino, G. — 
Weitere untersuehungen fiber 
die gegenwart der Spirochete 
pallida in den schnitten 
primarer, sekundarer und ter- 
tiarer syphilis — Centralbl. f. 
Bakteriol., 1 Abt., Jena, 1906, 
xli, 74-78, 1 pi. 

Bertarelli, E. e Volpino, G. — 
Ulteriori ricerche sulla pre- 
senza di spirochete pallida 
nelle sezioni di lesioni sifilit- 
iche primarie, secondarie e ter- 
ziarie — Gior d. r. Accad. di 
med. di Torino, 1906, 4 s., xii., 
6-11. 

Bertarelli, E. — Sulla transmissione 
della sifilide al coniglio — Riv. 
d'ig. e san. pubb., Torino, 1906, 
xvii, 269-275, 1 pi. 

Bertarelli, E. — Spirochete pallida e 
osteocondrite sifilitica — Riv. 
d'ig. e san. pubb., Torino, 1906, 
xvii, 335-340. 

Bertarelli, E. — Sulla transmissione 
della sifilide al coniglio — Riv. 
d'ig. e san. pubb., Torino, 1906, 
xvii, 646-660. 

Bertarelli, E. — Spirochete pallida 
und osteochondritis — Centralbl. 
f. Ba,kteriol., 1 Abt., Jena, 
1906, xli, 639-642, 1 pi. 



Bertarelli, E. — Ueber die transmis- 
sion der syphilis auf das kan- 
inchen — Centralbl. f. Bakte- 
riol., 1 Abt., Jena, 1906-7, xliii, 
Orig. 167. 

Bertarelli, E. — Ueber die transmis- 
sion der syphilis auf das kan- 
inchen — Centralbl. f. Bakte- 
riol., 1 Abt., Jena, 1906, xli, 
320-326. 

Bertarelli, E. e Volpino G.— Ul- 
teriori richerche sulla presenza 
di spirochete pallida nelle sex- 
ioni dilesioni sifilitiche pri- 
maire, secondaire, terziare — 
Progresso med., Torino, 1906, 
v, 42. 

Bertarelli, E. — II virus sifilitico 
corneale del coniglio e la recet- 
tivita delle seimie inferiori e 
delle cavie a questo virus — Riv. 
d'ig. e san. pubb., Torino, 1907, 
xviii, 250-269. 

Bertarelli, E. — Sulla recettivita 
dei carnivori (cane) e dei ru- 
minanti (pecora) alia sifilide 
sperimentale — Gior. ital. d. 
mal ven., Milano. 1907, xlii, 
137. 

Bertarelli, E. — I fatti acquisiti 
sulla eziologia della sifilide — 
Rassegna di terap., Torino, 

1907, vi, 161. 

Bertarelli, E. — Das virus der horn- 
haut syphilis des kaninchens 
und die empfanglichkeit der 
unteren affenarten und der 
meerschweinchen fiir dasselbe — 
Centralbl. f. Bakteriol., 1 Abt., 
Jena, 1907, xliii, Orig. 448- 
455. 

Bertarelli, E. — Ueber die empfang- 
lichkeit der fleischfresser 
(Hund) und der wiederkauer 
fur experimentelle syphilis — 
Centralbl. f. Bakteriol., 1 Abt., 
Jena, 1907, xliii, Orig., 790- 
793. 

Berti, G. — Nota circa la conveni- 
enza di tornare alia poivere 
grigia degli inglesi per la sifili- 
ide degli infanti — Bull. d. sc. 
med. di Bologna, 1907, 8 s. vii, 
533-548. 

Bertier — Un nouveau-ne syph- 
ilitique — Lyon med., 1905, cv, 
57. 

Bertin — La prophylaxie de la syph- 
ilis — Echo med, du nord, Lille, 

1908, xii, 577-589. 



302 



Recent Bibliography. 



Bertin. — Syphilis maiigne precoee; 
absence d'eruption sur un mem- 
bra atteint de paralysie infan- 
tile, Echo med. dii nord, Lille. 
1906, x, 19. 

Bertin. — A propos d'un cas d'arth- 
ropathie svphilitique tertaire — 
Echo med.' du nord, Lille, 1906, 
x, 39-42. 

Bertin et Breton. — Preparations 
de spirochetes par Schaudinn et 
Hoffmann comme specifiques des 
affections syphilitiques — -Echo 
med. du nord, Lille, 1905. ix, 
360. 

Bertin et Petit, G. — Recherches sur 
le sero diagnostic de la Byph- 
ilis — Echo med. du nord, Lille. 
1908. xii, 241-245. 

Berzbrizhiy. I. M. — Two cases of 
syphilitic ecthyma — Russk. j. 
kozhn. i. ven. boliezn. Kharkov, 

1905, ix, 481. 
Bettencourt. Ferreira J. — A spiro- 

cheta da syphilis — J. Soc. d. 
sc. med. de Lisb., 1905, Ixix. 
121-124. 

Bettencourt. N. — Soro-diagnostic de 
la syphilis — Arch. d. r. Inst, 
bactriol. Camara Restana, Lisb.. 
1908. ii, 273-307. 

Betti. U. A. — Due casi di ittero si- 
filitico dei neonati — Clin, os- 
tet.. Roma, 1906. viii. 32-36. 

De Beurmann et Gougerot — Cheloi- 
des secondaires a des cicatrices 
syphilitiques (nature infectie- 
use des cheloides) — Bull. soc. 
franc, de dermat. et syph.. 
Paris, 1905, xvi, 298-304. 

De Beurmann et Gougerot, H. — La 
pian et la syphilis, maladies 
spirillaires — Rev. de med., 
Paris. 1907. xxvii. 401-437. 

Bidwell. L. A. — Rodent ulcer occur- 
ring in a tertiary syphilitic ul- 
cer — West Lond. M. J.. Lond., 

1906. xi. 197. 

Birt. A. — The fever of late visceral 
syphilis: its diagnostic difficul- 
ties — Montreal M. J., 1905, 
xxxiv. 748-757. 

Birt. C. — The new method of detect- 
ing latent syphilis — J. Roy. 
Army Med. Corps. Lond.. 1907, 
viii. 567-573. 

Bird. F. D. — Abdominal syphilis — 
Australas. M. Gaz., Sydney, 
1905, xxiv, 446-459. 



Bisher, P.— Report of a case of con- 
genitally inherited syphilis — 
Am. J. Dermat. and Genito- 
Urin. Dis., St. Louis. 1907, xi, 
118. 

Bizard, L. — Contagion de la syphilis 
par le rasoir — Soc. franc, de 
prophyl. san. et mor. Bull., 
Paris, 1905, tome v. 245-256. 

Bizard. L. — Contagion de la syphilis 
par le rasoir — J. de med. int., 
Paris. 1909, xiii, 216-218. 

Bizard, L. — Diagnostic de la syphilis 
par l'ultramicroscope ; comment 
on doit prelever et recuellir les 
serositee destinees a la re- 
cherche du treponeme pale par 
l'ultramicroscope — J. de med. 
de Paris. 1909, 2 s. xxi, 263. 

Bizard. L. — Diagnostic de la syphilis 
par l'ultramicroscope — Rev. 
prat, d'obst. et de pediat., Paris, 
1909. xxii, 234-238. 

Bizard et Laffont — Chancre syphili- 
tique du doigt (base de l'annu- 
laire droit) consecutif a un 
coup de poing sur la bouche — 
Ann. d. mal ven., Paris, 1906, 
i, 354. 

Blanchard. L. F. — Le microbe de la 
syphilis (spirochaete pallida 
Schaudinn) - — Dauphine med., 
Grenoble, 1905, xxix, 181. 

Blanchard, L. F. — La syphilis chez 
Irs singes et la genealogie de 
l'homme; evolution phyloge- 
nique de la maladie chez les 
primates — Dauphine med., Gre- 
noble, 1906, xxx, 108-115. 

Blanck — Die bewertung der Wasser- 
mannschen reaktinn fiir die be- 
handlung der syphilis — Berl. 
klin. Woch., 1909, xlvi, 1652- 
1654. 

Blaschko, A. — Der einfluss der 
syphilis auf die lebensdauer — 
Ber. u. Verhandl. d. internat. 
Kong. f. Versicher — Med. Berl., 

1906, 95-140. 

Blaschko. A. — Spirochaete pallida 
eine vorlaufige entgegnung (an 
W. Schulze und O. Frieden- 
th-.il I— Berl. klin. Woch., 1906, 
xliii, 1265. 

Blaschko, A. — Die spirochaete pal- 
lida und ihre bedeutung fur 
den syphilitischen krankheits- 
prozess — Berl. klin. Woch., 

1907, xliv, 336. 



Recent Bibliography. 



303 



Blaschko, A. — Ueber spirochaeten- 
befunde im syphilitischerkrank- 
ten gewebe — Med. Klin., Berl., 
1906, ii, 335-339. 

Blaschko, A. — Weitere beitrage zur 
kenntnis der spirochete pallida 
—Med. Klin., Berl., 1906, ii, 
915-917. 

Blaschko, A. — Die bedetung der 
serodiagnostik fur die patholo- 
gie und therapie der syphilis — 
Berl. klin. Woch., 1908, xlv, 
694-699. 

Blaschko, A. — Die bedeutung der 
serodiagnostik der syphilis fur 
die praxis — Med. Klin., Berl., 
1908, iv, 1179-1182. 

Blaschko, A. — Ueber die klinisehe 
verwertung der Wassermanns- 
chen reaktion — Deutsche med. 
Woch., Leipz. u. Berl., 1909, 
xxxv, 383-390. 

Blaschko, A. — De l'influence de la 
syphilis sur la vie humaine — 
Bull, de l'Ass. mternat. d. med.- 
exp. de comT). d'assur., Brux., 
1906, v. 146. 

De Blasi, A. — Sifllide — Riv. inter- 
naz. di clin. e terap., Napoli, 
1908, iii, 37-39. 

Bloch, L. — La pretendue syphilis 
prehistorique — Bull, et mem. 
Soc. d'anthrop. de Paris, 1906, 
5 s. vii, 202-207. 

Bloch, M. — Quelques cas de syphilis 
tertiaire res voies aeriennes 
superieures et du pharynx — 
Ann. d. mal ven., Paris, 1906, 
i, 293-300. 

Bloch, M. — Syphilides tertiaires os- 
tracees du pavilion et du con- 
duit auditif externe — Ann. d. 
mal ven., Paris, 1907, ii, 855. 

Bloch, M. et Nathan — Un cas de 
chancre intra-nasal — Ann. d. 
mal ven., Paris, 1908, i. 36. 

Blumenfeld, A. — Serum diagnosis in 
syphilis — Lwow. tygidn. lek., 
1908, iii, 315-317. 

Blumenthal — Serumdiagnostik bei 
syphilis — Berl. klin. Woch., 
1908, xlv, 572. 

Blumenthal, F. u. Roscher — Ueber 
die bedeutung der Wasser- 
mannschen reaktion bed der 
syphilis wiihrend der ersten 
der infektion folgenden jahre — 
Med. Klin., Berl., 1909, v. 241- 
244. 



Blumenthal, R. — Un cas de spheno- 
megalie aleucemique avec rate 
mobile suite de syphilis — Clin- 
ique, Brux., 1905, xix, 1005- 
1016. 

Blumer, G. — The etiology of syph- 
ilis; a review of the important 
articles of the past two years 
—Yale M. J., N. Haven, 1906-7, 
xiii, 157-162. 

Bluth, G. — Zur aetiologie und genese 
des tertiarluetischen spatrezi- 
divs— Med. klin., Berl., 1907, 
iii, 1328. 

Boas, H. — Den diagnostiske serum- 
reaktion ( Wassermann-reac- 

tion) ved akvisit syfilis og par- 
asyfllis — Hosp-Tid., Kobenh., 
1909, 5 R. ii, 115. 

Boas, H. — Die Wassermannsche re- 
aktion bei aktiven und inak- 
tiven sera — Berl. klin. Woch., 
1909, xlvi, 400-402. 

Boas, H. — Die bedeutung der Was- 
sermannschen reaktion fur die 
therapie der syphilis — Berl. 
klin. Woch., 1909, xlix, 588. 

Bochkovski, P. — Three cases of non- 
sexual syphilitic infection — 
Protok. omsk. med. obsh., 1904- 
5, xxii, 79. 

Bodin, E. — Spirochete pallida dans 
la syphilis hereditaire — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 190. 

Bodin, E. — Spirochete pallida dans 
les lesions syphilitiques — Bull, 
soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 319. 

Bodin, E. — Spirochete pallida dans 
des lesions syphilitiques — Bull. 
Soc. scient. et med. de 1'ouest 
Rennes, 1905, xiv, 311. 

Bodin, E. — Conduite a tenir en pres- 
ence d'un cas douteaux de 
chancre syphilitique — Clinique, 
Paris, 1908, iii, 628. 

Bogart, T. N. — Etiology of syphilis; 
with a few practical points in 
tertiary cases of several years' 
standing — Med. Herald, St. 
Joseph, 1906, xxv, 49-56. 

Bogrow, S. L. — Ein fall von unge- 
wohnlicher lokalisation des 
syphilitisehen primaraffektes — 
Monatsh. f. prakt. dermat., 
Hamb., 1907, xliv, 163. 

Boinet et Rouslacroix — Pouls lent 
permanent chez un dissociation 
du rythme cardiaque chez un 



304 



Recent Bibliography. 



syphilitique — Arch. gen. de 
nied., Paris, 1906, ii, 2497-2503. 

Boing, H. — Legendenbildung in der 
medizin spirochseta pallida — 
Aertzl. Rundschau, Miinchen, 
1907, xvii, 505-507. 

Boix, E. — A propos du microbe de 
la syphilis — Arch. gen. de nied., 
Paris, 1905, tome i, 1515. 

Bonhofl' — Ueber die aetiologie der 
syphilis — Sitzungsber d. Ge- 
sellsch. z. Bedford d. ges 
Naturw. zu Marb., (1904), 
1905, 17-31. 

Bonnard et Mauriac — Recherche du 
spirochete dans les tissus des 
heredo-syphilitiquea — J. de med. 
de Bordeaux, 1908, xxxviii, 636. 

Bonnet, L. M. et Bernard — Gangrene 
de la verge occasionnee par un 
chancre syphilitiques — Lyon 
med., 1907, cix, 260-263. 

Bonnet, L. M. — Syphilide acneique 
et piistuleuse — Lyon med., 1907, 
cviii, 520. 

Bonnet, L. M. — Lesions terliaircs 
sur venues cinquante-quatre ans 
apres le chancre — Lyon med., 

1907, cix, 745. 
Bonnet-Laborderie. A. — Foetus syph- 
ilitique ne vivant avec des le- 
sions cutanees tres marques 
mort apres 7 hemes de respira- 
tion artificielle — J. d. sc. med. 
de Lille, 1905, tome i, 511. 

Bonnet-Laborderie. A. — De la mort 
subite des enfants heredo-svph- 
ilitiques immediatement apres 
la naissance — Pratique Jour., 
Lille. 1907-8, 260-273. 

Bonnet. L. M. — Perforation de la 
voute palatine chez un nou- 
veau-ne heredo-svphilitique — 
Lyon med., 1908, ex, 307. 

Bonnet, L. M. — Syphilidea en corym- 
bes papules geantes — Lyon med., 

1908, ex, 369. 

Bonnet, L. in., et Courjon — Cliancres 
multiples — Lyon med., 1908, 
cxi, 1040. 

Bonnet, L. M. — Pigmentation consid- 
erable de la muqueuse buccale 
chez un sujet presentant un 
tres legere pigmentation cuta- 
nee d'origine phtiriasique rein- 
fection syphilitique — Lyon 
med., 1909,' cxii, 600-602. 

Bonnet, P. — Gommes syphilitiques 
precoses — Ann. d. mal. ven., 
Paris, 1907, ii, 608-613. 



Bonnet, L. H. et Courjon — Lesions 
syphilitiques considerables des 
os du crane — Bull. soc. med. d. 
hop. de Lvon, 1909, viii, 175- 
177. 

Booth, R. T. — Specific ulceration of 
genitals — China M. J., Shang- 
hai, 1908, xxii, 97, 1 pi. 

Bord, B. — Chancres syphilitiques 
mains de la levre et de la 
langue— Ann. de dermat. et 
syph., Paris, 1906, 4 s. vii, 666- 
669. 

Bord, B. — Gommes syphilitiques 
multiples prises pour des le- 
sions tuberculeuses, syphilis 
des fosses nasales, destruction 
exclusive et totale de la cloison 
cartilagineuse — Ann. de der- 
mat. et Byph., Paris, 1907, 4 s., 
viii, 49. 

Bord, B. — Des reactions appendicu- 
laires au cours de la syphilis 
secondairs — Compt. rend. Soc. 
de Biol., Paris, 1907, lxiii, 481- 
483. 

Bordet, J. — Sur le spirille de la 
syphilis — Presse med. beige, 
linix.. 1905, lvii. 614. 

Bordet, J. — Le spirille syphilitique 
chez le chimpanze preparation 
de Metschnikoff — Soc. roy. d. 
sc. med. et nat. de Brux, Bull., 
1905, lxiii, 150. 

Von den Borne, E. W. K. — Spiro- 
chete pallida Castellani — 
Nederl. Tijschr. v. Geneesk., 
Amst.. 1906, ii. 889-898. 

Von den Borne. E. W. K. — Observa- 
tions on the presence of the 
spirochete pertenuis (Castel- 
lani) in years; result of the 
examination of 128 cases — J. 
Trop. M., Lond., 1907. x. 345. 

Borodenko, F. — On the possibility of 
exchanging the syphilitic ex- 
tract for artificial mixtures in 
Wassermann's serodiagnostic re- 
action — Russk. j. kozhn. i. ven. 
boliezn, Kharkov, 1909, xvii, 
241-246. 

Borowiecki, S. — Transitory psycho- 
sis and disturbed sensation fol- 
lowing syphilis — Czasopismo 
lek., Lodz, 1905, vii, 240-245. 

Borrel. A. et Burnet, E. — Procede de 
diagnostic rapide des lesions 
syphilitiques — Compt. rend. 
Soc de biol., Paris, 1906, lx, 
212-214. 



Recent Bibliography. 



305 



Bosc, F. J. — A propos des lesions 
histologiques et de la classifi- 
cation de la maladie syphili- 
tique — Compt. rend. Soc. de 
biol., Paris, 1905, lix. 237. 

Bosc, F. J. — Recherches sur l'etiolo- 
gie la pathogenie et le traite- 
ment de la syphilis — Montpel. 
med., 1905, xxi, 1-19. 

Bosc, F. J. — Treponema pallidum 
(Schaudinn) dans les lesions 
de la syphilis hereditaire; 
formes de degenereseence des 
treponemes et Ieur resemblance 
avec spirochsete refringens — 
Compt. rend. Soc. de biol., 
Paris, 1906, lx, 338. 

Bosc, F. J. — Lesions de la syphilis 
du cerveau nieningo-encephalite 
chronique ; diffuse ulcereuse 
syphilitique associee a une 
syphilis sclero-gommeuse ■ — 
Compt. rend. Soc. de biol., 
Paris, 1906, lx, 731-733. 

Bosc, F. J. — Les maladies bryocy- 
tiques (Maladies a protozo- 
aires) ; 4 memoire la syphilis 
— Centralbl. f. Bakteriol., 1 
Abt., Jena, 1906, xli, 729. 

Bosc, F. J. — Gommes syphilitiques 
et treponemes; structure gen- 
erate et signication des gommes 
— Montpel. med., 1906, xxii, 
476-479. 

Bosc, F. J. — Treponema pallidum 
(Schaudinn) dans les lesions 
de la syphilis hereditaire; 
formes de degenereseence des 
treponemes et leur resemblance 
avec spirochete refringes — 
Montpel. med., 1906, xxii, 565- 
567. 

Boschi, G. — Una interessante sin- 
drome nervosa della sifilide sec- 
ondaria, contributo elinico — 
Riforma med., Napoli, 1908, 
xxiv, 907. 

Bosse, B. — Histologisches und rad- 
iologisches zur tardiven form 
der hereditaren gelenklues — 
Beitz. z. klin. Chir., Tubing., 
1906, li, 194-246. 

Boucabeille — Sur trois cas de syph- 
ilis a localisation peu frequente 
— Arch, de med. et pharm. mil., 
Paris, 1908, lii, 414-420. 

Du Bourguet — Guerison d'un cas 
d'impuissance d'origine syph- 
ilitique par les injections de 
liquide testiculaire — Gaz. d. 
hop. de Lyon, 1906, vii, 4-6. 



Bourrett et Chabal — Manifestations 
oculaires avec arthropathies 
dans un cas de syphilis heredi- 
taire — Marseille med., 1909, 
xlvi, 424-426. 

Boutin, G. — Hygiene et soins de la 
bouche chez les syphilitiques — 
J. de med. int., Paris, 1909, 
xlii, 256-258. 

Bouttiau, A. — Contribution a l'etude 
de la syphilis hereditaire de 2 
generations — J. d. mal. cutan, 
et syph., Paris, 1909, xx, 487- 
491. 

Bouveyron — Syphilis lymphangit- 
ique et ganglionaire d'emblee — 
Lyon med., 1907, cix, 103-107. 

Bovero, R. — Forme fruste di sifilide 
— Gior. ital. d. mal. ven. Mi- 
lano, 1908, xliii, 5-10. 

Bramwell, B. — The influence of 
syphilis on longevity — Clin. 
Stud., Edinb., 1905-6, iv, 96. 

Brahl, J. et Lyon-Caen, L. — Un cas 
de fistule broncho-biliaire au 
cours d'une syphilis slcero-gom- 
meuse hepatique et pulmonaire 
— Bull, et mem. soc. de hop. de 
Paris, 1909, 3 s. xxviii, 295-302. 

Bramwell, B. — Clinical lecture on 
congenital or inherited syphilis 
—Clin. Stud., Edinb., 1908-9, 
vii, 1-40. 

Bramwell, B. — Large syphilitic 
gumma of the right triceps 
muscle; severe pain, sleepless- 
ness; the persistence of the 
syphilitic poison notwithstand- 
ing prolonged treatement — Clin. 
Stud., Edinb., 1905-6, ns., iv, 
235-239. 

Bramwell, B. — Case of congenital 
syphilis; typical facies; physi- 
cal signs suggestive of com- 
mencing phthisis — Clin. Stud., 
Edinb., 1906-7, n.s., v, 360-362. 

Branch, C. W. — Rhino-pharyngitis 
mutilans— J. Trop. M., Lond., 
1906, ix, 156. 

Branch, W. J. — The factor of race 
in relation to the prevalence of 
syphilis among the inhabitants 
of the Leeward Islands — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1906, x, 409-412. 

Brandweiner, A. — Ueber den gegen- 
wartigen Stand der spiroehEeten- 
frage — Wien. klin. Wehnschr., 
1906, xix, 339. 



306 



Recent Bibliography. 



Brandweiner, A. — Versuclie ueber 
aktive imnmnisierung bei lues; 
erwiderung auf Dr. Kraus' be- 
merkungen zu dem aufsatz ver- 
suclie ueber aktive immunisie- 
rung bei lues — Wien. klin. 
Woch., 1905, xviii, 1276. 

Brault — Frequence des chancres 
dans la region sous-pubienne et 
a la base du penis cbez des indi- 
genes mussulmans d'Algerie — 
Bull. soc. franc, de dermat. et 
sypli.. Paris, 1909, xx, 155. 

Brault, J. — Les labialites tertiaires 
— Arch. gen. de med., Paris, 
1906, ii, 2342-2350. 

Brault, J. — La syphilis en Algerie — 
Archf. Sehiffs-u. Tropen-Hyg., 
Leipz., 190S, xii, 647-660. 

Brault. J. — Note sur l'historique de 
la syphilis en Alge — Janus, 
Amst., 1909, xiv. 2 pt. 740-748. 

Braunstein, A. — Ueber die Schur- 
mannsche farlionreaktion bei 
lue9 — Ztschr. f. klin. Med., 
Berl., 1909, Ixviii, 345-348. 

Brauser, H. — Zur frage der gum- 
mosen lvmphome des halses — 
Berl. klin. Woch., 1908, xlv, 108. 

Breakey. J. F. — Some difficulties in 
the diagnosis of syphilis— J. 
Mich. M. Soc, Detroit, 1905, iv, 
380. 

Breakey, J. F. — The influence of the 
discovery of the spirochete pal- 
lida on the treatment of syph- 
ilis — I. Am. M. Ass.. Chicago, 

1908, ii, 2034-2036. 

Breda, A. — Per completare il capi- 
tolo sulla bouba brasiliana — 
Gior. ital. d. mal. ven., Milano, 
1906. xli, 98-105. 

Breda. A. — La bouba del Brasile — 
Ann. di med. nav., Roma, 1907, 
i. i'!»3-339. 

Breton et \ outers — Gangrene de la 
main et de l'avant-bras gauche 
par arterite syphilitique diag- 
nostiques par la methode de 
Wassermann amputation mort 
— Echo med. du nord. Lille. 

1909, xii, 577-579. 

Brew, J. — A case of re-infection of 
syphilis — Am. J. Dermat and 
Genito-Urin. Dis., St. Louis, 
1906, x. 58-63. 

Brew. J. — Re-infection with syph- 
ilis: report of a case with her- 
editary syphilis in the child — 
Med. Rec'.. N. Y.. 1907, lxxii, 
138-141. 



Brezovszky, E. — Verblutung in folge 
von lues — Pest Med-chir. Presse, 
Budapest, 1908, xliv, 858. 

Von Brezovszky, M. — Unsere 
neueren erfahrungen iiber die 
Wassermannsche reaktion — Pest 
med-chir-Presse, Budapest, 1909, 
xlv, 321-333. 

Brissaud et Bauer — Meningo-mye- 
lite chronique syphilitique ap- 
parue 30 ans apres le chancre 
infeetant — Rev. neurol., Paris, 
1909, xvii, 94-96. 

Broc, R. — La syphilis cbez les indi- 
genes mussulmans de Tuni9 — 
Ann. d. mal. ven., Paris, 1909, 
iv. 483-501. 

Broca, A. — Syphilis hereditaire tar- 
dive — Tribune med., Paris, 

1908, ns. xl, 629-631. 

Broca, A. — Paresis avee contracture 
legere des membres inferieurs 
chez une heredro-syphilitique — 
Gazz. d. mal. infant, Paris, 

1909, xi. 65-68. 

Brockbank, E. M. — Post-mortem 
notes on syphilitic lesions— Med. 
Chron., Manchester, 1909-10, 1, 
319-334. 

Brocq — Syphilides acneiformes — 
Rev. gen. de clin. et de therap., 
Paris, 1909, xxiii, 325. 

Bronnum, A. o. Ellermann, V. — 
Spirocgaete pallida i milten af et 
syfilitisk foster (in the spleen 
of a syphilitis foetus) — Hosp. 
Tid., Kobenh., 1905, 4 R xiii, 
918. 

Bronnum. A. — Undersogelser over 
spirochete pallidas forekomst 
ved syfilis — Hosp. Tid., Kobenh., 
1906.' 4 R, xiv. 20. 

Brown. S. H. — Syphils; some neg- 
lected clinical observations — 
Am. J. Dermat., St. Louis, 
1905-6, ix. 97-103. 

Brown. P. — A Roentgenological 
study of certain manifestations 
of syphilis — Am. 0. Roentgenol, 
Pittsburg. 1906-7. i, No. 4, 8-14. 

Browne. R. H. J. — A case of tertiary 
syphilis terminating in sudden 
death from abductor paralysis 
of the vocal cords — Lancet, 
Lond., 1909. ii. 1350. 

Browning, C. H. and McKenzie, Ivy 
— The biological syphilis-reac- 
tion: its significance and 
method of application — Lancet, 
Lond., 1908, i, 1521- 1523. 



Recent Bibliography. 



307 



Browning, C. H. and MeKenzie, Ivy 
— Modifications of serum and 
organ extract due to physical 
agencies and their effect on the 
Wassermann syphilis reaction 
— J. Path and Bacterid., Cam- 
bridge, 1908-9, xiii, 325-330. 

Bruck — Die serodiagnostik der 
syphilis nach Wassermann-Neis- 
ser-Bruck — Verhandl. d. deutsch 
dermat. Gesellseh., Berl., 1908, 
x, 144-194. 

Bruck, C. — Die serodiagnostik der 
syphilis nach Wassermann, Neis- 
ser und Bruck — Arch. f. der- 
mat. u. syph., Wien u. Leipz., 
1908, xci, 337-354. 

Bruck, C. u. Stern, M. — Die Wasser- 
mann-A. Neisser-Brucksche re- 
aktion bei syphilis — Deutsche 
med. Woch., Leipz. u. Berl., 

1908, xxxiv, 401-459-504. 
Bruckner, J. — Une modification pra- 
tique du procede de Romanow- 
sky pour le sang et le treponeme 
— Compt. rend. Soc. de bid., 
Paris, 1908, Ixiv, 968. 

Bruhns, C. — Ueber aortenerkrank- 
ung bei congenitaler Syphilis — 
Berl. klin. Wchnschr., 1906, 
xliii, 217. 

Bruhns, C. — Eure erfahrungen und 
anschauen ueber die syphilitis- 
chen erkrankungen der cirkila- 
tions-organe bei acquirierter 
lues— Berlin klin. Woch., 1906, 
xliii, 513. 

Bruhns, C. — Die bisherigen resultate 
der experimentellen syphilisimp- 
fung — Berl. klin. Woch., 1906, 
xliii, 1548, 1573. 

Bruhns, C. — Diagnose und therapie 
der syphilitischen tertiaren 
zungensklerose — Aerztl. Prax., 
Berl., 1907, xx, 49. 

Bruhns, C. u. Lumme, G. — Ueber 
dauerbeobachtungen bei syph- 
ilis. Beitrage zur statistik 
ueber behandlung und verlauf 
der erkrankung — Arch. f. der- 
mat. u. syph., Wien u. Leipz., 

1909, xcv, 367-404. 

Bruhns, C. — Ueber die syphilis der 
unschuldigen — Mitt. d. deutsch. 
Gesellseh. z. bekampf. d. Gesch- 
lechtskr., Leipz., 1908, vi, 1-12. 

Bruhns, C. — Zur praktischen bedeu- 
tung der serodiagnostik der 
syphilis — Berl, klin. Woch., 
1909, xlvi, 149-152. 



Bruhns, C. — Die lebensprognose des 
syphilitikers — ■ Berl. klin. 
Wchnschr., 1907, iii, 1147-1152. 

Brunard et Lemoine — Un cas d'an- 
emie splenique pseudo-leucem- 
ique de Van Jasksch chez un 
nourrisson syphilitique — Clin- 
ique, Brux., 1905, xix, 281. 

Bruning — Demonstration von mit 
syphilis infizierten affen — Berl. 
klin. Wchnschr., 1906, xliii, 493. 

Bruns, H. D. — Inherited and ac- 
quired syphilis in the same sub- 
ject — Ophth. Bee, Chicago, 
1905, xiv, 424. 

Buchler, A. F. — Some observations 
on the extra-genital infection of 
syphilis — Med. and Surg. Rep., 
Presbyterian Hosp., N. Y., 1906, 
vii, 105-113. 

Bucura, C. J. — Geschlechtsverhaltnis 
der neugeborenen mit beson- 
derer berucksichtigung der ma- 
zerierten kinder — Zentralbl. f. 
Gynak., Leipz., 1905, xxix, 1177. 

Bue, V. et Petit, G. — Sur la pres- 
ence du spirochete dans les tis- 
sus des heredo-syphilitiques — 
Bull. soc. de med. du nord, 
1908; Lille, 1909, 202-211. 

Bue, V. et Petit, E. — Sur la presence 
du spirochete dans les tissus 
des heredo-syphilitiques — Presse 
med. Beige, Brux., 1908, Ix, 414- 
417. 

Bue, V. et Petit, E. — Sur la pres- 
ence du spirochete dans les tis- 
sus des heredo-syphilitiques — 
Echo med, du nord, Lille, 1908, 
xii, 205-208. 

Bulkley, L. D. — Syphilis as a dis- 
ease innocently acquired — J. 
Am. M. Ass., Chicago, 1905, 
xliv, 681. 

Bulkley, L. D. — Some plain truths 
about syphilis — Med. Record, 
N. Y., 1907, lxxii, 213. 

Bulkley, L. D. — Syphilis of the lips 
— J. Cutan. Dis. incl. Syph., N. 
Y., 1907, xxv, 281. 

Bull, C. S. — The deep intra-ocular 
lesions of infantile inherited 
syphilis and tardy inherited 
syphilis, from the standpoint of 
general pathology; diagnosis 
and treatment — Med. Rec, N. 
Y., 1908, lxxiii, 549-554. 

Bullitt, J. B. — Syphilitic bone lesion 
— Louisville Month. J. M. and 
S., 1904-5, xi, 398. 



308 



Recent Bibliography. 



Bunch, J. L. — Spirochaete in syphilis 

— Brit. J. Dermat., Lond., 1905, 

xvii, 412-415. 
Bunzel, E. — Zur serodiagnostik der 

lues in der geburtshiilfe — Wien. 

klin. Woch., 1909, xxii, 1230- 

1232. 
Buxaczynski, A, — Icterus in the 

early period of syphilis — Przegl. 

chorob skor i wen, Warszawa, 

1907, ii, 241-253. 
Buraczynski, A. — Ikterus im friih- 

stadium der lues — Wien. klin. 
Rundschau, 1907, xxi. 051-699. 
Bureau, G. — A quelle epoque et a 
quelles conditions peut-on auto- 
riser le mariage d'un syphilit- 
ique? — Gaz. med, de Nantes, 

1908, 2 s. xxvi, 645-650. 
Bureau. M. — Eruption confluente de 

syphilides acneiform — Gaz. med. 
de Nantes, 1905, 2 s. xxiii, 74. 

Bureau. M. et Brillouet — Chancre 
syphilitique du namelon — Gaz. 
med. de Nantes. 1906, 2 s. xxiv, 
1077. 

Bureau. M. et Bureau. G. — Eruption 
generalisee de syphilides en co- 
carde consecutive a la transfor- 
mation dee elements d'une rose- 
ole — Gaz. med. de Nantes, 1907, 
2 s. xxv. 1009-1011. 

Buret — Analyse de deux documents 
du xiii siecle relatifs a la syph- 
ilis — J. d. mal. cutan. et svph., 
Paris. 1905. xvii, 328-336. 

Buret — Analyse de deux documents 
du xiii siecle relatifs a la syph- 
ilis presentes an Congres d'Al- 
ger — Prog. med.. Paris. 1905, 3 
s. xxi, 324. 

Burgsdorf. V. — De la transmission 
hereditaire de la syphilis a la 
troisieme generation (keratite 
interstitielle comme symptome 
de la syphilis hereditaire a la 
troisieme generation) — Ann. de 
dermat. et svph.. Paris. 1908, 
ns. ix, 19-23. ' 

Burgsdorf. V. F. — Syphilitic re-in- 
fection with the presence of 
Schaudinn's spirochaeta — Russk. 
Vrach., S. Peterb., 1908, vii, 
146-148. 

Burnet. E. — Le spirochaete de la 
syphilis (Spirochaete pallida 
Schaudinn) morphologie et 
classification — Ann. de dermat. 
et svph., Paris, 1905, 4 s. vi, 
833-846. 



Burnet, E. et Vincent, C— Topo- 
graphic du spirochaete pallida 
Schaudinn dans !es coupes de 
chancre syphilitique — Compt. 
rend. Soc. de biol., Paris, 1905, 
lix, 474. 

Bums, F. S. — A case of papular 
ayphilide, with pronounced fol- 
licular hyperkeratosis — J. Cu- 
tan. Dis." incl. Syph., N. Y., 
1906, xxiv, 478. 

Burns, F. S. — A case of syphilis of 
the face — T. Cutan. Dis. incl. 
Syph., N. Y., 1906, xxiv, 483. 

Buschke, A. — Ehe und syphilis — 
Deutsches klinik, Berl. u, Wien, 
1905, x, 517-532. 

Buschke, A. — Leber die behandlung 
der svphilis hereditaire — Aerztl. 
Prax"., Berl., 1905, xviii, 157. 

Buschke, A. u. Fischer, W. — Leber 
das vorkommen von spirochaten 
in inneren organen eines syph- 
ilitischen kin<les — Deutsches 
med. Woch.. Leipz.. u. Berl., 

1905, xxxi, 791. 

Buschke, A. u. Fischer, W. — Leber 
die lagerung der spirochete pal- 
lida im gewebe — Berl. klin. 
Woch., 1906, xliii, 6. 

Buschke, A. u. Fischer, W. — Weitere 
beobachtungen ueber spirochaete 
pallida — Berl. klin. Wchnschr., 

1906, xliii, 383, 387. 
Buschke, A. u. Fischer. \V. — Zur in- 

fektiositat der malignen und 
tertiareu syphilis — Med. Klin., 
Berl., 1906." ii, 99-1001. 

Buschke, A. u. Fischer, \V. — Leber 
die beziehungen der spirochaete 
pallida zur kongenitalen syph- 
ilis nebst einigen bemerkungen 
ueber ihre lagerung im gewebe 
bei akquirierter lues — Arch. f. 
dermat. u. svph.. Wien u. 
Leipz., 1900, lxxxii, 63-110, 2 pi. 

Buschke, A. u. Fischer, W. — Ein 
fall von myocarditis syphilitica 
bei hereditarer lues mit spiro- 
chatenbefunde — Deutsche med. 
Woch., Leipz. u. Berl., 1906, 
xxxii, 752. 

Buschke, A. u. Fischer, W. — Zur 
frage der sogenannten syphilis- 
immunitat und der syphilitis- 
chen hodeninfektion bei affen — 
Berl. klin. Woch., 1909, xlvi, 
690-692. 

Buschke. A. — Spirochaten bei Syphi- 
lis — Tnternat. Dermat. Cong., 
N. Y. 1908, ii, 691-707. 



Recent Bibliography. 



309 



Bust, W. — Die praktischen konse- 
quenzen der Wassermannschen 
luesreaktion fiir den frauenarzt 
— Gynak. Rundschau, Berl. u. 
Wien, 1909, iii, 433-439. 

Butler and Flashman — The serum 
diagnosis of syphilis (Wasser- 
mann reaction) — Australas. M. 
Gaz., Sydney, 1909, xxviii, 
244-246. 

Butler, W. J. — Serum diagnosis of 
syphilis — Illinois M. J., Spring- 
field, 1908, xiv, 657-668. 

Butler, W. J. — The serum diagnosis 
of syphilis and its clinical value 
— Illinois M. J., Springfield, 
1909, xv, 388-402. 

Butler, W. J. — The serum diagnosis 
of svphilis and its clinical value 
— N. York M. J., 1909, lxxxlx, 
207-213. 

Butler, W. J. — Eye lesions of syph- 
ilis, from the standpoint of the 
general practitioner — Wash. M. 
Ann., 1905-6, iv, 337-345. 

Butler, W. J. — Serum diagnosis of 
syphilis— N. York M. J., 1907, 
lxxxvi, 1018-1021. 

Butler, W. J. and Mefford, W. T — 
Precipitate' reactions with lec- 
ithin sodium glycocholate and 
sodium taurocholate for the di- 
agnosis of syphilis (summary) 
— Tr. Chicago Path. Soc, 1907- 
8, vii, 213. 

Butler, W. J. and Mefford, W. T — 
Precipitate reactions with lec- 
ithin sodium glycocholate and 
sodium taurocholate for the di- 
agnosis of syphilis — N. York M. 
J., 1908, lxxxviii, 822-826. 

Butler, W. J. — Serum diagnosis of 
syphilis — J. Am. M. Ass., Chi- 
cago, 1908, li, 824-830. 

Butler, W. J. — The serum diagnosis 
of syphilis and its clinical value 
— Alabama M. J., Birmingh., 
1908-9, xxi, 198-216. 

Butschi, 0. — Bemerkung zu der mit- 
teilung von F. Schaudinn ueber 
spirochseta pallida — Deutsche 
med. Woch., Leipz. u. Berl., 
1906, xxxii, 71. 



Cabannes, C. — La keratite neuro- 
paralytique de la syphilis — 
Gaz. hebd. d. sc. med. de 
Bordeaux, 1909, xxx, 421-427. 



Cade, A. et Jambon, A. — Sur les le- 
sions broncho-pulmonaires de la 
syphilis tertiaire — Arch, de med. 
exper. et d'anat. path., Paris, 
1905, xvii, 649-663. 

Caillau — Sero-diagnostic de la 
syphilis et deviation du comple- 
ment — Tribune med., Paris, 
1909, ns. xli, 453-455. 

Calmette, A. — Methode simple de H. 
Noguchi pour le sero-diagnostic 
de la syphilis — Presse med., 
Paris, 1909, xvii, 226. 

Camp, C. D.— The difficulty of di- 
agnosticating betwen tabes and 
cerebro-spinal syphilis, with a 
report of two illustrative cases 
— Univ. Penna. M. Bull., Phila., 
1905-6, xviii, 167. 

Campana, R. — Come bisogna inter- 
pretare il fenomeno della spiro- 
chete pallida Hoffmanni nella 
sifilide — Riforma med., Palermo- 
Napoli, 1906, xxii, 934. 

R. — Un solido tentativo 
per la ricera della spirochete 
pallida abortito — Clin, dermo- 
sifilopat. d. r. Univ. di Roma, 

1907, xxv, 35. 

Campana, R. — Sulla non coltiva- 
bilita della spirocheta pallida — 
Gior. ital. d. mal. ven., Milano, 

1908, xlix, 220-222. 
Campana, R. — Una propagine della 

sierodiagnosi nella sifilide — 
Riforma med., Napoli, 1908, 
xxiv, 932. 
Campana, R. — Sifiloderma condi- 
lomatosa per sifilide ereditaria 
in barnbina da latte di circa 
un anno; sifiloma ulceroso al 
capezzolo mammario nella 
madre da un mese o poco piu — 
Bull. d. r. accad. med. di Roma, 

1909, xxxv, 74-76. 

Campana, R. — Sifiliderma condi- 
lomatosa per sifilide ereditaria 
in barnbina da latte di circa 
un anno; sifiloma ulceroso al 
capezello mammario nella 
madre da un mese o poco piu 
— Clin, dermosifilopat. d. r. 
Univ, di Roma, 1909, xxvii, 75- 
77. 

Campbell — Ueber gummose erkran- 
kung bei der nuclei caudati ; ein 
beitrag zur physiologie und 
pathologie der nuclei caudati 
des menschen — Berl. klin. Woch., 
1908, xlv, 449-451. 



310 



Recent Bibliography. 



Campbell, R. R. — The consideration 
of late hereditary syphilis — 
Med. News, N. Y., 1905, lxxxvii, 
673. 

Campbell, R. R. — -The diagnostic 
value of the triad symptoms in 
hereditary syphilis — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1906, x, 179-187. 

Campbell, G. S. — The cutaneous 
manifestations of tertiary 
syphilis — Montreal M. J., 1909, 
xxxviii, 7-13. 

Candidori, E. — Sifiliderma nodulo- 
rupioide epidermolisi corneif- 
icante sparsa — Clin. dermo- 
sifilopat. d. r. Univ. di Roma, 
1905, xxiii, 119, 1 pi. 

Canto. P. — Sobre las causas de fiebre 
mercurial al comienzo de la in- 
fecion sifilitica — Rev. med. de 
Chile, Sant de Chile, 1908, 
xxxvi, 33-37. 

Capdevila, J. — Sifilis hereditaria 
hernia inguinal derecha — Med. 
de los ninos, Barcel., 1907, viii, 
352-354. 

Cappelli, I. e Gavazzeni, G. A. — 
Contribute) di richerche e 
considerazioni critiche sul 
valore pratico della sierodiag- 
nosi Wassermann nella sifilida 
— Riv. crit. di clin. med., 
Firenze, 1909, x, 445-153. 

Cappelli, J. e Gavazzeni, G. A. — 
L'azione del mercurio sulla 
spirochete pallida — Gior. ital. 
d. mal. ven.. Milano, 1907. xlii. 
411-424, 1 pi. 

Cappelli, J. — Richerche sulla spiro- 
chaeta pallida nei sifilomi prim- 
itivi e in alcune dermatosi 
sifilitiche- — Gior. ital. d. mal. 
ven., Milano, 1908, xliii, 305- 
340. 

Cappuecio, D. — Un caso di sifilide 
congenita con sindrome eclamp- 
sica ed emorragica — Riv. di 
clin. pediat., Firenze, 1906, iv, 
907-922. 

Caraco — Un cas d'heredo-syphilis 
seconde — Clinique. Brux., 1906, 
xx. 346-351. 

Carbone, A. — Manifestazioni oculari 
tardive sifilide ereditaria — 
Clin, ocul., Palermo, 1905, 1991- 
1994. 

Carillo, R. — Apuntes sobre la heredo- 
sifilis — Gac. med. de Mexico. 
1909, 3 s. iv, 662, 697. 



Carito, D. — Esiste la sifilide con- 
cezionale? — Gior. internaz. d. 
sc. med., Napoli, 1908, xxx, 1- 
66. 

Carini, A. — Sind die vaccin-erreger 
spirochseten? — Centralbl. f. Bak- 
teriol, 1 Abt., Jena, 1905, xxxix, 
685. 

Carle — Tertiarisme precoce (chancre 
phagedenique et perforation du 
voile du palais) — Bull. Soc. 
franc, de dermat. et syph., Paris 
1906, xvii, 309-312. 

Carle — Notes sur l'influence com 
paree des generateurs dans 
l'heredo-syphilis — Ann. de der- 
mat. et svph.. Paris, 1908, 4s 
i\, 93-98. 

Carnevali, A. — Le manifestazioni 
acneiche del periodo recente 
della sifilide — Policlin., Roma, 
xxi, sez. prat. 172. 

De Carolis, A. — La sifilide da con- 
cepimento in rapporto alia pro- 
filassi, alia terapia e alia med- 
icina legale — Corriere Ban., Mi- 
lano, 1906, xvii, 90-101. 

Carpenter, D. N. — Fever in tertiary 
svphilis — Med. Rec, N. Y., 
1906, lxix. 412-414. 

Carpenter, G. — Inherited svphilis — 
Rep. Soc. Studv Dis. Child., 
Lond., 1908, viii, 116-158. 

Carpenter. G.— Some experiences 
and observations on congenital 
svphilis in infants — Brit. J. 
Child. Dis., Lond., 1908, v, 35- 
48-93-152. 

Carrasquilla. H. T. — Sifilis experi- 
mental — Rev. med. de Bogota, 
1905-6, 104, 108, 150. 

Carriere, G — Sur quelques mani- 
festations gastriques de la 
svphilis — Tribune med., Paris, 
1908. n. s. xl, 789-791. 

Carriere — Macroglossie congenitale 
et syndrome de Thomsen ( Rap. 
de G. Variot)— Bull. Soc. de 
pediat. de Paris, 1906, viii, 140. 

Cartis, D. — Esiste la sifilide con- 
cezionale ? — Gior. internaz. d. 
sc. med.. Napoli, 1908, ns. xxx, 
1-15. 

Caruccio — Sifilide ed artropatie — 
Gior. ital. d. mal. ven., Milano, 
1908. xlix, 295. 

Casagrandi, O. e De Luca, R. — Se 
nei filtrati di manifestazioni 
sifilitische ottenuti attraverso 
candele berkefeld, comuni V. 



Recent Bibliography. 



311 



N. W. Chamberland F., si trovi 
l'agente dell'infezione — Ann. 
d'ig. sper., Roma, 1906, ns. xvi, 
23-48. 

Casiki, M. — Spirochseta pallida in 
lues — Budapesti orv uj sag, 
1905, iii, 921. 

Cassel, J. — Die gefahren der syph- 
ilisuebertragung in modernen 
siiuglingsstationen — Arch. f . 
kinderh., Stuttg., 1908, 1, 141- 
154. 

Cassel, J. — Statistisehe beitrage zur 
sauglingsstationen — Arch. f. 
kinderh., Stuttg., 1908, 1, 154- 
163. 

Cassin, P. et Igonet et Pestre — 
Treponeme et heredo-syphilis — 
Bull, et mem. Soc. d'Avignon, 
1907, iii, 588. 

Castaing — Proposition de modifica- 
tion au gobelet actuel du Char- 
nier — Arch. de med. nav., 
Paris 1907, Ixxxviii, 350-353. 

Castellani, A. — On the presence of 
spirochaetes in two cases of 
ulcerate parange (yaws) — 
Brit. M. J., Lond., 1950, ii, 
1280. 

Castellani, A. ■ — Untersuchungen 
ueber framboesia tropica 
(yaws) — Deutsche med. Wchn- 
sehr., Leipz., u. Berl., 1906, 
xxxii, 132-134. 

Castellani, A. — Experimental inves- 
tigations on framboesia tropica 
(yaws) — J. Hyg., Cambridge, 
1907, vii, 558-569, 2 pi. 

Castellani, A. — Framboesia troppica 
Arch. f. Schiffs u. Tropen Hyg., 
1907, xi, 19-38. 

Castellino, P. F. — Infezione celtica 
arteriosclerosi ; influenza ; aor- 
tite acuta (forma di Hodgson) 
compTessione della vena cava 
discendente irritazione del 
pneumogastrico — Tommasi, 
Napoli, 1905-6, i, 107. 

Castells, E. — El tabaco en la sif- 
ilis — Rev. med. d. Sevilla, 
1909, Iii, 165-169. 

Castex- — Sur di mutite par heredo- 
syphilis — Arch, internat. de 
laryng., Paris, 1908, xxv, 1077. 

De Castro, F. — Caracteres do can- 
cro syphilitico; syphilis cere- 
bral — Gaz. clin., S. Paulo, 
1905, iii, 391-398. 

Caucci, Q. L. — Inoculazione di pro- 
dotti sifilitiei nella cornee di 



conigli senza trovare spiro- 
chete spegazione delle forme 
consimili trovate — Clin, der- 
mo-sifilopat. d. r. Univ. di 
Roma, 1908, xxvi, 127. 

Caucci, Q. L. — Inoculazioni di pro- 
dotti sifilitiei nelle cornee di 
conigli senza trovare spirochete 
spiegazione delle forme con- 
simili trovate — Bull. d. r. Ac- 
cad, med. di Roma, 1908, 
xxxiv, 455-484. 

Caudron, L. — Incontinence nocturne 
d'origine hysterique chez un 
adulte syphilitique guerison — 
Nord med., Lille, 1905, xi, 114. 

Cauli, G. — Sifilide e ritardata cica- 
trizzazione — Gazz. med. di 
Roma, 1909, xxxv, 253-259. 

Caussade et Milhit — Cirrhose syph- 
ilitique metasplenomeglique et 
a forme hypersplenomegalique 
— Bull, et mem. Soc. med. d. 
hop., Paris, 1905, 3 s xxii, 769- 
782. 

Cautley, E. — Bilateral periostitis 
of the femora, probably syph- 
ilitic — Rep. Soc. Study Dis. 
Child., Lond., 1905, v, 232-235. 

Cauvin, C. — Du chancre indure des 
paupieres — ■ Arch. d'ophth., 
Paris, 1909, xxix, 612-623. 

Cavallaro, J. — Syphilis in its rela- 
tion to dentition — Dental Cos- 
mos, Phila., 1908, 1, 1161; 
1325; 1909, li, 16; 156. 

Ceconi, A. — Febbre sifilitica? — Riv. 
crit. di clin. med., Firenze, 

1905, vi, 189-194. 

Ceconi, A. — Febbre sifilitica ? — Ri- 
forma med., Napoli, 1908, xxiv, 
397-403. 

Charmeil — Etat de la question de 
l'etude experimentale de la 
syphilis — Nord med., Lille, 
1908, xiv, 22-24. 

Charpentier, A. — Meningite chron- 
ique syphilitique conjugale — 
Rev. neurol., Paris, 1906, xiv, 
550. 

Chattot — Alterations dentaires at- 
tributes a la syphilis — Lyon 
med., 1905, cv, 854. 

Chiarabba, U.— Contributo alia cono- 
scenza della sifilide ombelicale 
(flebite proliferativa gommosa 
della vena ombelicale) — Gior. 
di ginec. e di pediat., Torina, 

1906, vi, 97-101. 



312 



Recent Bibliography. 



Chiarabba. U. — Contribute! alia con- 
oscenza della sifllide ombelicale 
(flebite proliferativa gonimosa 
della vena ombelicale) — Ann. 
di estete., Milano, 1906, i, 190- 
198. 

Chirivino, V. — II treponema pallido 
nelle lesioni del periodo terzi- 
ario — Gior. internaz. d. bc. 
med., Napoli, 1909, ns. xxxi, 
289-310. 

C'hirvino. N. — lntorno agli innesti 
dei prodotti sifilitiei nell' occbio 
del coniglio — Rifornnv med., 
Napoli, 1909. xxv.. 706. 

C'hirvino, V. — Sifiloderma psoriasi- 
forme tardivo della palme della 
mani — Riforma med., Napoli, 
1908, xxiv, 143-145. 

Chirvino. V. et Consoli, N. — Acne 
sifilitica — Riforma. Napoli, 
1908, xxiv, 481, 508, 537. 

Chirivino, V. — Sulla importanza 
della ricerca del treponema pal- 
lido in talune lesioni eliniea- 
mente sospette — Riforma med., 
Napoli, 1908. xxiv, 1099-1102. 

Chlenoff, M. A. — Recent tendencies 
in syphilology (experiments on 
monkevs) — Russk. Vrach, S. 
Petersb., 1907, vi, 328. 362, 408. 

Chlenoff, M. A. — Experimental 
svphilis in apes — Russk. Vrach, 
St. Petersb., 1906, v, 1297, 
1332. 

Chlenoff. M. A. — Serum diagnosis 
of svphilis — Russk. Vrach., S. 
Petersb.. 1908. vii. 253. 297, 
407. 480. 

Chompret — Chancre de la gencive — 
Roll. Soc. franc, de dermat. et 
syph.. Paris, 1905, xvi, 72. 

Chornoguboff, N. A. — Simple method 
of serum diagnosis of svphilis — 
Prakt. Vrach.. St. Pete'rb.. 1908. 
vii, 707. 

Chrzelitzer — Syphilis und der spiro- 
chsetenfund — Reich-Med. Anz., 
Leipz., 1906. xxxi. 203-206. 

Cicero. R. — Se deben aplicar los 
principios de la responsibilidad 
civil y penal a la transmission 
de 1 a sifilis — Gac. med., de 
Mexico, 1905, 2 s v, 112, 115. 

Cicero. R. — Algunos commentaries 
a la tesis inaugural del Dr. 
Zenon Luna, titulada "El chan- 
cre fagedencio es communmente 
sifilitico" — Cron. med. Mecicana, 
Mexico, 1906, ix, 261-264. 



Citron, J. — Die serodiagnostik der 
syphilis — Berl. klin. Wchnschr., 

1907, xliv, 1370-1373. 

Citron. J. — Demonstration einer 
neuen methode zur serodiag- 
nostik der lues— Berl. klin. 
Woch., 1908, xlv, 469. 

Citron, J. — Die bedeutung der mod- 
ernen syphilisforschung fiir die 
bekampfung der svphilis — 
Berl. klin. Woch., 1908, xlv, 
518-524. 

Citron, J. u. Reicher, K. — Unter- 
suchungen ueber das fettspal- 
tungsvermiigen syphilitischer 
sera und die bedeutung der 
lipolyse fiir die serodiagnostik 
der lues — Berl. klin. Woch., 

1908, xlv, 1398. 

Citron. J. u. Reicher, K. — Unter- 
suchungen ueber das fettspalt- 
ungsvermiigen syphilitischer 
sera und die bedeutung der 
lipclyo2 fiir di; strcdiagnostik 
der lues — Verhandl. d. Berl. 
med. Gesellsch., (1908), 1909, 
xxxix, 2 teil, 287-292; Discus- 
sion. 1 teil, 115-231. 

Citron T. — Liber a-rtenin .ufh: i:nz 
und lues — Berl. klin. Wchnschr., 
Leipz. u. Berl., 1908, xlv, 2142- 
2146. 

Ciuffin, C. — Tentativi di cuti ed 
oftalmo-reazione nella sifilide — 
Gazz. med. ital., Torino, 1909, 
lx. 423. 

Ciuffo, G. — Sulla siero reazioni di 
Porges nella sifilide — Bol. d. 
Soc. med. chir. di Pavia, 1908, 
xxii. 183-188. 

Ciuffo, G. — Sulle norme pratiche 
d'invigilanza igienica e profilat- 
tica da seguirsi nei piefotrofi 
per imperire la transmissione 
della sifilide con l'alattamento— 
Gior. d. r. soc. ital. d'ig., 
Milano, 1909, xxxi, 345-362. 

Ciuffo, G. — Su alcune particolarita 
morfologiche della spirocheta 
pallida — Bull. d. soc. med-chir. 
di Pavia, 1908, xxii, 88-95, 
1 pi. 

Ciuffo. G. — Su alcune propneta 
biochemiche del sangue di sif- 
ilitic — Gior. ital. d. mal. ven., 
Milano. 1908, xliiii, 417-455. 

Civatte. A. — A quelles conditions 
peut-on autoriser le mariage 
des syphilitiques? — Ann. de 
dermat. et svph., Paris, 1907, 
4 s. viii, 141-152. 



Recent Bibliography. 



313 



Civatte — Syphilides peripilaires et 
iritis syphilitique — Bull. soc. 
franc, de dermat. et syph., 
Paris, 1909, xx, 292. 

Clarke, J. J. — A note on syphilis 
and cancer, etc., and on some 
protozoa — Brit. M. J., Lond., 
1906, i, 1274-1276. 

Clauda — Une observation d'angine 
fuso-spirillaire de Vincent au 
cours de la syphilis secondaire 
— Arch, internat. de laryngol., 
Paris, 1908, xxv, 196. 

Clemenger, F. J. — The diagnosis of 
syphilis by some laboratory 
methods — Brit. M. J., Lond., 
1909, ii, 575. 

Coble, P. B. — Hyperemesis, syph- 
ilitic in origin, with sponta- 
neous recovery — Centr. States 
M. Month., Indianap., 1906, ix, 
795-797. 

Cocks, E. L. — Chancre of the lower 
lip — J. Cutan. Dis. incl. Syph., 
N. Y., 1908, xxvi, 526. 

Cocks, E. L. — Circinate syphilide 
in a colored woman — J. Cutan. 
Dis. incl. Syph., N. Y., 1908, 
xxvi, 530. 

Coenen, H. — Die praktische bedeu- 
tung des serologischen syphilis 
nachweises in der chirurgie — 
Beitr. z. klin. chir. Tubing, 
1908, lx, 265-295, 3 pi. 

Cogliati-Dezza, G. — Alcuni easi di 
sifiloma elefentiasco — Clin, der- 
mosifllopat. d. r. Univ. di 
Roma, 1905, xxiii, 94. 

Cohen, C. — Die serodiagnose der 
syphilis in der ophthalmologic 
— Berl. klin. Woch., 1908, xlv, 
877-882. 

Cohn, G. — Deszendierende stenosen- 
bildung der luftwege auf grund 
von lues hereditaria tarda — 
Arch. f. Laryngol. u. Rhinol., 
Berl., 190S-9, xxi, 490-503. 

Cole, F. H. and Stephens, H. D — 
Case of congenital syphilis 
( Spirochseta pallida demon- 
strated ) — Intercolon M. J., 
Australas, Melbourne, 1906, xi, 
271, 1 pi., Discussion 277. 

Cole, G. L. — Lues as a factor in 
general practice — South. Calif. 
Pract., Los Angeles, 1906, xxi, 
335-341. 

Coles, A. C. — Spirochoeta pallida 
methods of examination and 



detection especially by means 
of the dark-ground illumina- 
tion—Brit. M. J., Lond., 1909, 
i, 1117-1120. 
Collins, C. D. — Syphilitic skin le- 
sions and their differential 
diagnosis — Clinique, Chicago, 

1906, xxvii, 267-271. 

Collin, L. — Sur un cas de diagnos- 
tic bacteriologique de la syph- 
ilis avec lesions initiales mul- 
tiples — Gaz. hebd. d. sc. med. 
de Bordeaux, 1907, xxviii, 254. 

Comandon, J. — Diagnostic du tre- 
peneme pale a l'ultra-micro- 
seope — Ann. d. mal. ven., Paris, 
1909, iv, 96-110. 

Comby, J. — Lesions dentaires 
heredo-syphilitiques — Bull. soc. 
de pediat., Paris, 1905, vii, 
333. 

Comby, J. — Syphilis hereditaire a 
forme ganglionnaire — Arch, de 
med. d' enf., Paris, 1905, viii, 
605. 

Conn, F. M. — Non-venereal syphilis 
— Northwest Med., Seattle, 

1907, v. 118. 

Constantini, F. — La deviazione del 
complemente nell' infezione 
sifilitica e nelle affezione para- 
sifilitiche — Polielin., Roma, 

1908, xv, sez. med., 235; 267. 
Coolidge, Emelyn L. — A case of 

hereditary syphilis — Bull, Ly- 
ing-in-Hosp., N. Y.. 1907, iv, 
89-91. 

Cooper, A. — Some unusual varia- 
tions of the erythematous 
syphilide — Brit. M. J., Lond., 
1906, i, 316. 

Cooper, A. — On the significance of 
scars of the genital region in 
the retrospective diagnosis of 
syphilis — Brit. M. J., Lond., 
1905, vol. 1, p. 130. 

Corbus, B. C— - The value of the 
spirochete in the diagnosis of 
syphilis with special reference 
to the primary lesion — Illinois 
M. J., Springfield, 1909, xv, 
402-404. 

Cornelius, R. — La presence de spi- 
rochetes dans le sue des gan- 
glions lymphatiques chez les 
syphilitiques — Arch. gen. de 
med., Paris, 1905, tome i, 1318. 

Cornet, P.— Schopenhauer a-t-il eu 
la syphilis? — Chron. med., 
Paris, 1906, xiii, 657-659. 



314 



Recent Bibliography. 



Correia, Dias — Les rapports entre 
la syphilis et la tuberculose — 
Rev. internat. de la tuberc, 
Paris, 1905, viii, 163-171. 

Corson. E. R. — Syphilis in the ne- 
gro — Am. J. Dermat. and Gen- 
ito-Urin. Dis., St. Louis, 1906, 
x, 240-247. 

Costantini, F. — La deviazione del 
complements nell' infezione 
sifilitica e nelle affezioni para- 
sifilitiche — Policlin, Roma, 
1908, xv ; sez. med. 235-267. 

Cottell, H. A. — Congenital syphilis — 
Louisville Month. J. M. and S., 
19 5-6, xii, 363-365. 

Courcoux, A. et Ribadeau-Dumas, 
L. — L'angiocholite syphilitique 
— Ann. d. mal. ven., Paris, 
1908, i, 21. 

Courtellemont — De la valeur du 
spirochetes pallida dans le di- 
agnostic de la svphilis — Nord 
med. Lille, 1905, xi, 245. 

Cox, \V. H. — The spirocheta pal- 
lida and its variations — Brit. 
M. J., Lond., 1906, ii, 140. 

Creite. O. — Ueber dactylitis syph- 
ilitica — Deutsche Ztschr. f. 
Chir.. Leipz., inns. xcii. 70-78. 

Crendiropoulo, M. — Sur le mecan- 
isme de la reaction Bordet- 
Gengou — Ann. de l'Inst. Pas- 
teur. Paris, 1908, xxii, 728-751. 

Cripps, H. — A clinical lecture on 
syphili»— Clin. J., Lond.. 1908, 
x'xxiv. 119-126. 

Crist. .1. D. — Chancroidal conjunc- 
tivitis—Denver M. Times, 1907- 
8, xxvii, 14. 

Crowley, D. F. — Bacteriology and 
pathology of syphilis, with a 
few of its clinical features — 
Iowa M. J., Des Moines, 1907- 
8, xv, 509-516. 

Crume, G. P. — Clinical diagnosis of 
earlv syphilis — Med. Brief, St. 
Louis, 1907, xxxv, 100. 

Csiki, M. — Spirochete pallida in 
syphilitischen Gebilden ■ — Pest, 
med. chir. Presse, Budapest, 

1906, xlii, 5-9. 

Csillag, J. — Eein rezentes erythema 
ezsudativum an cinem lueti- 
schen individium — Pest. med. 
chir. Presse. Budapest, 1908, 
xlix, 66. 

Cubanes, E. — Heredo-sifilis con 
pneumonia blanca muerete — 
Med. de los ninos, Barcel., 

1907, viii, 143. 



Cumston, C. G. — Surgical syphilis — - 
Internat. Clin., Phila., 1907, 
17. s. ii, 112-124, 1 pi. 

Cumston, C. G. — The cerebro-spinal 
fluid in the tertiary period of 
svphilis — Am. Med., Phila., 
1906, ns. i, 169. 

Curioni, F. — The mercurial reaction 
as an element of diagnosis in 
syphilis — Lancet, Lond., 1908, 
ii. 1810. 

dishing, E. F. — Infantile syphilis — 
Am. J. Dermat. and Genito- 
Urin. Dis., St. Louis, 1906, x, 
151-157. 

Cushing. H. B. — Congenital svphilis 
—Montreal M. J., 1906,* xxxv, 
66-68. 



Dahlenburg. C. W. — Etiology and 
general pathology of acquired 
svphilis — Toledo M. and S. 
Reporter, 1909, xxxv, 258-265. 

Dalous. E. — La spirochete pallida 
de M. M. Schaudinn et Hoff- 
mann et la bacteriologie de la 
syphilis — I. d. mal cutan. et 
svph., Paris, 1905, xvii, 481. 

Dammert, F. — Leber intermittier- 
endes fieber bei tertiarer vis- 
ceral (speziell leber) syphilis 
— Deutsche med. Woch.. Leipz., 
u. Berl., 1908, xxxiv, 1507-1510. 

Dandois — Un cas d'heredo syphilis 
revelee dans l'age adulte par 
des dystrophies ungueales — 
Rev. med. de Louvain, 1905, 
ns. ii, 337-341. 

Dandois — Un cas de chancre dur de 
la conjonetive hnlbaire — Rev. 
med. de Louvain, 1909, 209-216. 

Dandois — Etude sur les chancres 
extra-genitaux et le diagnostic 
de la svphilis — Rev. med. de 
Louvain, 1900. 241 ; 273. 

Danielopolu. D. — Sero-reaction de 
la syphilis dans les affections 
de 1'aorte et des arteres — 
Compt. rend. soc. de biol. 
Paris, 1908, lxiv, 971. 

Danlos — Syphilis hereditaire tar- 
dive et syphilide pigmentaire — 
Bull. Soc. franc, de dermat. et 
svph., Paris, 1905, xvi, 24. 

Danlns et Deherain — Macules atro- 
phiques syphilitiques — Bull. 
Snc. franc, de dermat. et svph., 
Paris. 1906, xvii, 152. 



Recent Bibliography. 



315 



Danlos — Chancrelle induree avec 
dehiscence lineaire du ganglion 
suppure correspondant — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1906, xvii, 357. 

Danlos Deroye et Gaston — Proba- 
bilite de syphilis ignoree et 
de syphilide psoriasiforme ter- 
tiaire insuffisance de l'examen 
histologique — Bull. soc. franc, 
de dermat. et syph., Paris, 
1907, xviii, 33. 

Danlos et Deroye — Chancre syph- 
ilitique de l'oeil — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 96. 

Danlos — Ecrouelles syphilitiques in- 
guinales — Bull. Soc. franc, de 
dermat. et syph., Paris, 1908, 
xix, 133. 

Danlos et Blanc — Heredo-syphilis 
tardive chez un sujet ne pre- 
sentant pas d'alteration du sys- 
teme dentaire — Bull Soc. franc, 
de dermat. et syph., Paris, 
1907, xviii, 356-358. 

Danlos et Blanc — Deux cas de syph- 
ilis secondaire chez des mal- 
ades atteints de glossite exfol- 
iatrice marginee avec langue j 
scrotale — Bull. Soc. franc, de 
dermat. et syph., Paris, 1907, 
xviii, 442-444. 

Danziger, F. — Zur friihdiagnose der 
syphilitische primaraffekte — 
Berl. klin. Woch., 1906, xliii, 
1365. 

Dardenne, H. — Herpes as a compli- 
cation of a syphilitic chancre 
of penis — Med. Presse and 
Circ. Lond., 1906, ns. lxxxii, 88. 

Dardenne, H. — A case of successive 
syphilitic chancres, one genital 
and the other extragenital — 
Med. Press and Circ, Lond., 
1906, ns. lxxxi, 199. 

Darier, J. — Syphilis arterielle on 
de 1'arterite syphilitique — 
Syphilis, Paris, 1906, iv, 86- 
109. 

David, C. — Chancre du cornet nasal 
inferieur lymphangite erysipel- 
ateuse de la joeu — Syphilis, 
Paris, 1905, iii, 125. 

Davidsohn, C. — Spirochaetenfarbung 
mit kresylviolett — Berl. klin. 
Woch., 1905, xlii, 985. 

Davis, H. — The serum diagnosis of 
syphilis — Brit. J. Dermat., 
Lond., 1909, xxi, 12-20. 



Davis, G. — Diagnosis of tertiary 
syphilitic lesions in the 
pharynx — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1906, x, 205-207. 

Davis, H. J. — Three cases of syph- 
ilis in one family ( ?) com- 
municated by oral infection 
from one to the other — J. 
Laryngol., Lond., 1906 xxi, 227. 

Davis, H. J. — A little girl, aged 
twelve, with a primary sore on 
the upper lip — J. Laryngol. 
Rhinol. and Otol., Lond., 1909, 
xxiv, 386. 

Davis, H. J. — Primary sore on the 
upper lip in a girl, aged 12 — 
Proc. Roy. Soc. Med., Lond., 
1909, ii, ' Laryngol. Sect., 163- 
165. 

Davis, R. H. — The tertiary mani- 
festations of syphilis — St. 
Louis M. Rev., 1907, Iv, 377. 

Davis, T. G. — Spiral organisms in 
relation to syphilis — Calif. J. 
M., San Fran., 1906, iv, 271. 

Davis — A case of multiple syph- 
ilitic gummata in a young girl 
— J. Cutan. Dis. incl. Syph., 
N. Y., 1909, xxvii, 170. 

Davlos et Levy-Frankel — Mai per- 
forant buccal de nature tabet- 
ique et syphilis en aetivite 
trente ans apres le chancre — 
Bull, et mem. soc. med. d. hop. 
de Paris, 1908, 3s. xxv, 736- 
763. 

Dayton, W. A. — The aural and 
nasal history of some syphilitic 
children — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 

1906, x, 165-167. 

Debove — Lesions syphilitiques mul- 
tiples tabes paralysie generale 
et insuffisance aortique — Gaz. 
d. hop., Paris, 1908, lxxxi, 243- 
246. 

Decrequy — Chancre syphilitique de 
la langue survenu apres une 
extraction dentaire chez un en- 
fant de huit ans — Rev. de sto- 
matol., Paris, 1907, xiv, 501. 

Delamarre, A. J. — Le pian et la 
syphilis — Tribune med., Paris, 

1907, ns. xxxix, 646. 
Delbanco — Zur klinik der syphilis 

sekundare gummibildung sive 
gummose lymphdruseninfektion 
— Miinchen med. Wchnsehr., 
1909, lv, 2565. 



316 



Recent Bibliography. 



Delbanco, E. — Etat degenere zur 
klinik der parasyphilis — Mon- 
atsh. f. prakt. Dermat., Hamb., 
1909, xlviii, 214-219. 

Delbanco, E.— Sekundare gunimibil- 
dung sive gummose lymph- 
druseninfektion zur klinik der 
spiitsyphilis — Monatsh. f. prakt. 
dermat., Hamb., 1909, xlviii, 
95-104. 

Delearde et Pierret — Arthropathia 
bilaterale du genou liee a 
l'heredo-svphilis — Echo med. du 
nord, Lille, 1909, xiii, 579-581. 

Dendrinos, G. u. Beusis, W. — Ueber 
funde von spirochete pallida 
im kreisenden blute — Dermat. 
Ztscbr.. Berl., 1906, xiii, 637. 

Denis, J. — Rein mobile gauche chez 
un heredo-syphilitique — Clin- 
ique, Brux., 1905, xx, 572. 

Denis. J. — Rein mobile gauche chez 
un heredo-syphilitique — Poli- 
clin., Brux., 1906, xv, 235. 

Derveaux, H. — Syphilis secondaire 
tardive meningocorticale, car- i 
diaque, hepatique, et cutane i 
guerison — J. d. sc. med. de 
Lille, 1905, tome i, 558. 

Derveaux, H. — Syphilis secondaire I 
tardive meningocorticale, cardi- 
aque, hepatique, et cutanee 
guerison — Nord med., Lille, 

1905, xi, 59. 

Desplats. R. — Gomme syphilitique 
de la moustache simulant un 
sycosis rebelle au traitement 
mercuriel, guerie par six se- 
ances de radiotherapie — Bull, 
off. Soc. franc, d'electrother, 
Paris. 1906, xiv, 27-30. 

Desprechins — Gommes syplnlitiques? 
— Polielin., Brux..' 1906, xv. 
210. 

Detre, L. and Brezowsky. E. — A 
syphilis serum reaction — Or- 
v'osi hetil., Budapest, 1908, Hi, 
541; 557: 576. 

Detre. L. — A syphilis serumreac- 
tioja — Orvosi hetil, Budapest, 

1906, 1. 584. 

Detre. L. — Ueber den nachweis von 
spezifischen syphilsantisubstan- 
zen und dereu antigenen bei 
luetikern — Wien klin. Woch.. 
1906, xix, 619. 

Deve. F. — Hepatite syphilitique ter- 
tiaire febrille — Normandie med., 
Rouen, 1908, xxiv, 555-557. 



Devic, E. et Froment, J. — Un cas 
de syphilis hereditaire tardive 
du f oie ; revue critique des ob- 
servations anterieures — Ann. de 
dermat. et syph., Paris, 1906, 
4. s.. vii, 97-122. 

Devic, E. et Beriel, L. — L'apoplexie 
hepatique dans la syphilis; 
considerations sur les ruptures 
spontanees du foie — Ann. de 
dermat. et syph., Paris, 4 s. 
vii. 642-665. 

Devic — Lesions symetriques des deux 
tibias — Lvon med., 1909, cxii, 
1156. 

Diaz, y Triana, J. — El microbio de 
la sifilis — Rev. espan. de der- 
mat. ^ sif MadnJ 190;. vin 
289-297. 

Didier et Payenneville — Chancre de 
I'amygdale avec syphilides va- 
rioliforme — Normandie med., 
Rouen, 1908, xxiii, 123-126. 

Didier et Payenneville — Chancre de 
la gencive — Normandie med., 
Rouen, 1908, xxiii, 126-128. 

Didriklison, V. K. — Hysterical arth- 
ralgia iu a syphilitic — Russk. 
j. kozhn. i. ven. boliezn, Khar- 
kov, 1905, ix, 450. 

Didriklison, V. K. — Malignant syph- 
ilis from a recent viewpoint — 
Yuvenno-med. J. St. Petersb., 
1906, ecxv, med. spec, pt., 336- 
342. 

von Dieballa, G. — Heredo-generation 
und konigeuitale lues — Deutsche 
Zt*ehr. f. Nervenli., Leipz., 
1908-1909, xxxvii. 149-160. 

Dieulafoy — La labialite syphilitique 
tertiaire — Rev. gen. de clin. et 
de therap., Paris, 1905, xix, 819. 

Dieulafoy — Angine de poitrine et 
syphilis ignoree — J. de med. et 
ehir. prat., Paris, 1905, lxxvi, 
730. 

Dieulafoy — Localizaciones region- 
ales inveteradas de la sifilis 
terciari — Escuela de med., Mex- 
ico, 1906, xxi, 529-534. 

Dieulafoy — Localisations regionales 
inveterees de la syphilis ter- 
tiaire — Arch. gen. de med., 
Paris, 1906, i, 224-230. 

Dieulafoy — La syphilis tertiaire in- 
veteree — Rev. gen. de clin. et 
de therap., Paris. 1906, xx, 54. 

Dittrich, E. W. — Two cases of syph- 
ilis hereditaria tarda — ^Post- 
Graduate, N. Y., 1909, xxiv, 
356-359, 2 pi. 



Recent Bibliography. 



317 



Dohi, K. — A recent discovery as to 
the cause of syphilis — Sei-i- 
Kwai M. J., Tokyo, 1905, xxiv, 
No. 285, 14-20. 

Dohi, K. — A recent discovery as to 
the cause of syphilis — Sei-i- 
Kwai M. J., Tokyo, 1905, xxiv, 
No. 285, 14. 

Dohi, K. u. Tanaka, T.— Ueber die 
spirochete pallida. (Ausz. pt. 
2, 12.) (Japanese text) — 
Hifubyog. kiu Hiniokibyog. 
Zasshi, Tokyo, 1905, v, 537- 
575, 1 pi. 

Dohi, K. — Spirochete pallida aus 
syphilis exanthem. (Ausz., 
Hft. 24). (Japanese text) — 
Mitt. d. med. Gesellsch, zu 
Tokyo, 1905, xix, 1092-1096. 

Dohi, K. — The spirochete as the 
origin of syphilis — Tokyo Iji- 
Shinshi, Tokyo, 1905, 2139. 

Dohi, K. and Tanaka, T.— The 
spirochete pallida — Hifubyog 
kiu Himokiboyog Zashi, Tokyo, 
1906, vi, 408-412. 

Dohi, S. — Ueber das vorkonrmen der 
spirochete pallida im gewebe 
nebst einigen bemerkungen 
ueber spirochetenfarbung und 
die kernfarbung mit silber im- 
pragnierter priiparate — C'en- 
tralbi. f. Bakteriol., Abt. 1, 
Jena, 1907, xliv, Orig. 246-256. 

Dohi, S. — Ueber die lokalen Veran- 
derungen nach injektion un- 
loslicher quecksillberpriiparate 
insbesondere des grauen oels — 
Dermat. Ztschr., Berl., 1909, 
xvi, 1-18. 

Dohi, S. — Tatowierung und syphilis 
— Arch. f. dermat. u. syph., 
Wien u. Leipz., 1909, xcvi, 3- 
20. 

Doktor, A. — 1st die syphilis eine 
schwerere erkriinkung als die 
gonorrhoea? — Ungar. med. 
Presse, Budapest, 1905, x, 429. 

Dolgopoloff, N. M. — Syphilis of the 
internal organ — Russk. J. 
kozhn. i. ven. boliezn, Khar- 
kov, 1907, xiii, 375-380. 

Domernikova, Mme. A. N. — Spiro- 
chete pallida in the lungs in a 
case of pneumonia — Russk. 
Vrach, S. Petersb., 1906, v, 664. 

Donald, W. M. — Syphilitic jaundice 
— Detroit M. J., 1908, viii, 
169-171. 



Donald, W. M. — Syphilitic dyspnoea 
—Detroit M. J., 1908, viii, 171. 

Donath, K. — Der heutige stand der 
serodiagnostik bei syphilis — 
Munchen med. Woch., 1909, 
Ivi, 946. 

Donath, K. — Ueber die Wasser- 
mannsche reaktion bei aorten- 
erkrankungen und die bedeu- 
tung der provokatorischen 
quecksilberbehandlung fur die 
serologisehe diagnose der lues — 
Berl. klin. Woch., 1909, xlvi, 
2015-2018. 

Donzello, G. — Lo spirochete pallido 
di Schaudinn come agente pa- 
togeno della sifilide — Gazz. 
sicil. di med. e chir., Palermo, 
1906, v, 101-105. 

Dore, S. E. — Case of syphilitic erup- 
tion in a man' with psoriasis — 
Proc. Roy. Soc. Med., Lond., 
1908-9, ii', Dermat. Sect., 31. 

Dorland, W. A. W. — The modern 
views of congenital syphilis — 
Am. J. Dermat. and Genito- 
Urin. Dis., St. Louis, 1906, x, 
349-355. 

Douglas, A. G. — Syphilis; signifi- 
cance of its primary lesions — 
Alabama M. J., Birmingh., 
1904-5, xvii, 424-434. 

Doutrelepont — Ueber spirochete 
pallida — Deutsche med. 
Wchnschr., Leipz., u. Berl., 
1906, xxxii, 404. 

Doutrelepont u. Grouven — Ueber 
den naehweis von spirochete 
pallida in tertiarsyphilitischen 
produkten — D e u t s c h e med. 
Woch., Leipz. u. Berl., 1906, 
xxxii, 908. 

Doutrelepont — Spirochete pallida in 
befarbten schnittpraparat — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 1060. 

Doutrelepont — Ueber spirocheta 
pallida bei tertiarer lues — Ver- 
handl. d. deutsch. dermat. Ge- 
sellsch., Berl., 1907, 291. 

Dreyer, A. — Beitrage zur spirochat- 
enfrage ■ — Internat. Dermat. 
Cong. Tr., N. Y., 1908, ii, 
739-749. 

Dreyer — Fall von maligner lues — 
Dermat. Ztschr., Berl., 1906, 
xiii, 643-646. 

Dreyer — Spirochetenbefunde in 
spitzen kondylomen — Dermat. 
Centralb)., Leipz., 1906, x, 34. 



318 



Recent Bibliography. 



Dreyer — Ueber spirochaetetenbefunde 
in s p i t z e n condylomen — 
Deutsche med. Woch., Leipz. u. 
Bert., 1907, xxxiii, 720. 

Dreyer ■ — Die differentialdiagnose 
der spiroehaeten in schnitt- 
prii para ten — Med. Klin., Berl., 
1906, ii, 1340. 

Dreyer, A. — Ueber blutungen aus 
den weibliehen genitalien bei 
syphilis — Dermat. Ztschr., 
Berl., 1906, xiii, 537-546. 

Dreyer u. Toepel — Spirochete pal- 
lida im win bei syphilitischer 
neuritis — Dermat. Centralbl., 
Leipz.. 1906, ix, 172. 

Dreyer — Die bedeutung der spiro- 
ehaten fiir die pathologie — 
Beichs Med. Anz., Leipz., 1908, 
xxxiii. 1, 23, 46. 

Dreyer — Ueber mischinfektion bei 
syphilis — Verhandl. d. deutsch 
dermat. Gesellsch., Berl., 1908, 
x. 229-232. 

Druelle — Heredo-syphilis et hypos- 
padias — Ann. d. mal. ven„ 
Paris, 1909. iv, 193-195. 

Druelle et Joltrain — Des syphilis 
zoniformes — Ann. d. mal. ven., 
Paris, 1909, iv, 417-428. 

Dubar — Mortification partielle de 
l'iris consecutive a une arter- 
ite cerebrale chez une syph- 
ilitique hereditaire — Echo med. 
du nord, Lille. 1907, xi, 245. 

Dubois-Havenith — Un cas de chan- 
cre infectant du canal de 
l'urethre — Presse med. beige, 
Brux.. 1900. Iviii, 173-177. 

Dubois-Havenith — Un cas de syph- 
ilis des lichenoides general- 
isees — Presse med. beige, Brux., 
1906, lviii, 557. 

Dubois-Havenith — Chancre infectant 
du menton — Presse med. beige, 
Brux.. 1906, lviii, 716-718. 

Dubreuilh — Syphilis maligne pre- 
coce destructive et mutilante — 
Gaz. hebd. d. sc. med. de Bor- 
deaux, 1905. xxvi, 90. 

Dubreuilh. W. — Deux cas de 
chancre indure de l'anus — J. de 
med. de Bordeaux, 1909, xxxix, 
693. 

Duckworth. Sir D. — Syphilitic 
cachexia — Hospital, Lond., 
1908, xliv, 223-225. 

Dudgeon. L. S. — The staining re- 
actions of the spiroehsetse 



found in syphilitic lesions — 
Lancet, Lond., 1905, ii, 522. 

Dudgeon, L. S. — The presence of 
the spirochaeta pallida in syph- 
ilitic lesions — Lancet, Lond., 
1906, i, 669. 

Duhot — Un cas de glossite syph- 
ilitique parenchymateuse ap- 
parue a la periode secondaire — 
Presse med. beige, Brux., 1906, 
lviii. 559-562. 

Duhot — Un cas apparent de syphilis 
d'emblee — Presse med. beige, 
Brux., 1906, lviii, 558. 

Duhot — Un cas apparent de syphilis 
d'emblee — Presse med, beige, 
Brux., 1906, lviii, 682. 

Duhot — Chancre de l'urethre chez 
un hypospadique — Presse med. 
beige," Brux., 1906, lviii, 991. 

Duhot — Un cas de syphilis rupioide 
hemorrhagique generalise — 
Presse med. beige, Brux., 1906, 
lviii, 992-994. 

Dumora et Anglade — Ulceration 
syphilitique de la Ievre infer- 
ieure consideree a tort comme 
ulceration tuberculeuse — J. de 
mod. de Bordeaux, 1905, xxxv, 
45. 

Dunal — Chancre de l'index— Mont- 
pel, med., 1908, xxviii, 64-66. 

Dunal — Syphilis maligne expulsion 
du vomer — Montpel. med., 1908, 
xxviii, 60-69. 

Dunal — Localisation anormale d'un 
chancre syphilitique — Montpel. 
med., 1908. xxvi, 161. 

Duncan. R. B. — The surgical as- 
pects of syphilis — Australas. M. 
Cong. Tr.. Victoria, 1909, i, 
402-406. 

Dunlop, G. H. — Syphilitic synovitis 
in children — Tr. Med. Chir. 
Soc. Edinb.. 1905, ns. xxiv, 21- 
30. 2 pi. 

Dunn, P. — A case of ophthalmo- 
plegia, tertiary syphilis and 
epithelioma of the tongue — 
West Lond. M. .1., Lond., 1907, 
xii. 214-216. 

Duprat — Deux cas de syphilis 
hereditaire ( larges syphulides 
ulcereuses du cou) — Ann. d. 
mal. ven.. Paris, 1908, iii. 572- 
582. 

Duvall. C. iVi. and Toad, J. L.— A 
note on the cultivation of 
spirochseta Duttoni — Lancet, 
Lond., 1909, i, 834. 



Recent Bibliography. 



319 



Dyachkoff, N. N. — Non-sexual chan- 
cre — Rusak. j. kozhn. i. ven. 
boliezn, Kharkov, 1905, ix, 75, 
244. 

Dyachkoff, N. N. — Three cases of 
non-sexual hard chancre — 
Eussk. j. kozhn. i. ven. boliezn, 
Kharkov, 1905, x, 24. 

Dyachoff, N. N— Syphilis of the 
nails and surrounding parts, 
with simultaneous disease of 
the heart and kidneys — Prakt. 
Vrach., St. Petersb., 1905, iv, 
557-577. 



Ebstein, E. — Die krankheit des 
Konigs Ladislaus von Neapel — 
Med. Woche, Berl., 1906, vii, 
88. 

Ebstein, W. — Einige erfahrungen 
ueber die chronischen erkrank- 
ungsformen der leber bei der 
erworbenen syphilis — Deutsches 
Arch. f. kiin. med., Leipz., 
1907-8, xcii, 236-254. 

Edson, B. — Clinical notes on heredi- 
tary syphilis — Pediatrics, N. 
Y., 1909, xxi, 78-80. 

Ehlers — Syfllis — i. Kjobenhavn. 
Ugeskr. 1 Laeger, Kjobenh., 
1908, lxx, 241-245. 

Ehrenfreund, F. — Ueber angeborene 
kindersyphilis — Sachs Heban.- 
Ztg., Dresd., 1908, i, 37-40. 

Ehrlieh, H. and Lemartowicz, J. — . 
On the methods of staining the 
spirocheta pallida for diagnos- 
tic purposes — Prezl. lek., Kra- 
kow, 1908. xlvii, 33-35. 

Ehrlieh, H. u. Lemartowicz, J. — 
Ueber farbungen der spiro- 
chaete pallida fiir diagnostische 
zwecke — Wien. med. Woch., 
1908, lviii, 1018-1023. 

Ehrmann, S. — Ein neues gefassymp- 
tom der syphilis, seine be- 
ziehungen zur cutis marmorata 
zum grossmakulosen syphilid 
und zur spirocheta pallida — In- 
ternal Dermat. Cong. Tr., N. 
Y., 1908, ii, 763-777. 

Ehrmann, S. — Ueber die peri und 
endo-lymphangitis syphilitica — 
Arch. f. dermat u. syph., 
Wien u. Leipz., 1906, Ixxxi, 
179-195. 

Ehrmann, S. — Ueber lichenformige 
syphilide — Wien. med. Woch., 
1905, lv, 1973. 



Ehrmann, S. — Ueber befunde von 
spirochete pallida in den ner- 
ven des priiputiums bei syph- 
i 1 i t i a c h e r initialsklerose — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 1115. 

Ehrmann, S. — Ueber spirochetenbe- 
funde in den syphilitischen 
geweben — Wien med. Woch., 
1906, lvi, 1905-1908. 

Ehrmann, S. — Zur topographie der 
spirochate pallida in der krus- 
tos werdenden papel — Dermat. 
Ztschr., Berl., 1906, xiii, 393- 
400, 1 pi. 

Ehrmann, S. — Veriinderungen in 
dem lymphgefassen bei syphilis 
—Wien. klin. Woch., 1906, xix, 
647. 

Ehrmann, S. — Die phagozytose und 
die dengenerationsformen der 
spirochete pallida in primaraf- 
fekt und lymphstrang — Wien 
klin. Woch., ' 1906, xix, 828. 

Ehrmann, S. — Atheromatose der 
aorta gyrierte spiitform von tu- 
bercula cutanea syphilitica — 
Wien klin. Woch., 1906, xix, 
1297. 

Ehrmann, iS. — Ueber die beziehungen 
der spirocheta pallida zu den 
lymph und blutahnen — Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena, 1907, xliv, Orig. 223-245, 
1 pi. 

Ehrmann. S. — Ein neues gefass 
symptom bei lues — Wien med. 
Woch., 1907, Ivii, 777. 

Ehrmann, S. — Versuche ueber auto- 
infektionen bei syphilis — Ver- 
handl. d. deutsch dermat. Ge- 
sellseh., Berl., 1907, 265-270. 

Ehrmann, S. — Ueber spirocheta pal- 
lida in syphilitischen gewebe — 
Verhandl. d. deutsch dermat. 
Osellsch., Berl., 1907, 295-300. 

Ehrmann, S. — Ueber die durch 
syphilitische gefassveranderun- 
gen bedingten gefassphanomene 
der haut — Verhandl. d. Kong, 
f. innere med., Wiesb., 1908, 
xxv, 192-196. 

Eichelberg, F. — Die serumreaktion 
auf lues mit besonderer be- 
riicksichtigung ihrer praktis- 
chen verwertbarkeit fur die 
diagnostik der nervenkrank- 
heiten — Deutsche Ztschr. f. 
Nervenh., Leipz., 1909, xxxvi, 
319-341. 



320 



Recent Bibliography. 



Einhom, M. — Ein fall von syph- 
ilitiseher geschwiilst dea ma- 
gens unci tier leber mittheilung 
— Internat. med. Rev., Berl., 
1907, i, 13. 

Eisendrath, D. N. — Syphilis heredi- 
taria tarda — Ann. Surg., Phila., 

1905, xli, 799. 

Eitner, E. — Ucber beobachtungen an 
der lebenden spirochete pallida 
— Mtinchen med. Woch., 1907, 
liv, 770. 

Elena, L. V. — Algunaa consider- 
acionea sobre un caso de goma 
sifilitico ulcerado <lo la lengua — 
Rev. med. de Sevilla, 1909, liii, 
136-139. 

Elfer, A. — Ueber einige eigenschaf- 
ten dea syphilitischen blut- 
serums vom immunochemischen 
standpunkte — Folia serolog., 
Leipz., 1909, iii, 461-470. 

Elias, H. — Ueber die spezifizitiit der 
Waasermannschen svphilisreak- 
tion— Wien klin. Woch., 1908, 
xxi, 652. 

Elias. H. — Theoretisches ueber die 
aerumreaktion auf syphilis — 
Wien klin. Woch., 1908, xxi. 
748-752. 

Elias, H. — Ueber die methodik und 
verwendbarkeit der an- ' 
ungareaktion fiir die serodiag- 
noae der syphilis — Wien klin 
Woch., 1908'. xxi, 831-834. 
De Elizalde, P. E.— El eapirillo 
de Schaudinn y la sifilis — Rev. 
Soe. med. argent.. Buenos 
Aire*. 1906, xiv. 98-116, 1 pi. 

De Elizalde. E.. y Wernicke. R. F. 
— Sobre la presencia del apiro- 
clu-ete pallida en las Ieaionea 
aifiliticas — Semana med., 
Buenos Aires. 1905, xii, 844. 

Ellermann. V., Thomsen, O. and 
Boas, H. — The estimation of the 
strength of Waasermami'a reac- 
tion— Hosp-Tid., Kjobenh., 1909, 
5 R. ii. 140-147. 

Emerson, H. A. — A case of congeni- 
tal syphilis with post-mortem 
notes — J. Roy. Army Med. 
Corps, Lond.. 1909, xiii. 681. 

Emery — Prophylaxie experimental 
de la syphilis: etat actuel de 
la question — Clinique. Paris. 

1906. i, 67. 

Emery — Manifestations tardives de 
la syphilia secondaire — Clin- 
ique. Paris, 1906, i, 232. 



Emery — Les adenopathiea de la 

avphilis aecondaire — Clinique, 

Paris, 1906, i, 454. 
Emery et Levy-Bing — Diagnostic de 

la syphilis par l'ultra-microa- 

cope — Clinique, Paris, 1909, iv, 

565. 
Emery — Quelles sont les conditions 

d'admissibilite au manage pour 

un svphilitique? — Clinique, 

Paris'. 1906, i, 643-645. 
Emery et Druelle — Heredo-syphilia 

et prurigo de Hebra — Ann. d. 

mal ven., Paria, 1906, i, 333. 
Emery et Lacapere — Le role du 

stomatologiste dans la syphilia 

— Rev. de atomatol, Paria, 

1908, w. 354-362; Discussion, 

373. 400. 
Engelen — Le diverse forme cliniche 

della sifilide cerebro-apinale — 

Gazz. med. Lomb., Milano, 1900, 

lxviii, 313-315. 
Engelmann, F. — Ein beitrag zur 

aerodiagnostik der lues in der 

geburtshilfe — Zentralbl. f. 

Gvnak., Leipz., 1909, xxxiii, 

85-89. 
Engelmann — Ein fall von lues 

haemorrhagiea — St. Petersb. 

med. Woch., 1905, xxx, 26. 
Entz, B. 4s Feldman. L. — Spiro- 

chaeta pallida bujakoros szer- 

vek goncosi metszeteihen. ( . . . 

in the microscopic sections of 

venereally diseased organs — Or- 

vosi hetil., Budapest. 1906, 1, 

261. 
Entz. B. — Ueber das vorkommen 

der spirochete pallida bei kon- 

genitaler syphilis — Arch. f. 

dermat. u. svph.. Wien u. 

Leipz. 1900. lx-cxi, 79-106. 2 pi. 
Epstein. H. B. — A case of malignant 

precocious syphilis — N. York M. 

J.. 1909. xc.'l220. 
Erdman. B. — A further note on 

spirocheta pallida — Indiana M. 

J., Indianap., 1908-9. xxvii, 147. 
Eschle, F. C. R. — Die neueren hy- 

pothesen ueber d i e syphi- 

lisaetiologie — Reichs Med. 

Anz.. Leipz., 1907, xxxii, 463, 

483. 
Espina — Sifilis cardio pulmonar — 

An. r. Acad. d. med.. Madrid, 

1907. xxvii. 290-294. 
Espinay, Capo — Estudio de fisiologia 

patologicn sifilis y tuberculosis 

— Rev. espan. de dermat. y sif., 

Madrid, 1908, x, 337-344. 



Recent Bibliography. 



321 



Esser — Zur kenntnis der kongen- 
italen nebennierenlues zugleich 
ein beitrag zur frage der ent- 
stehung isolierter nebennieren- 
tuberkulose — Mfinchen med. 
Woch., 1908, lv, 1170. 

Estivill, A. G.— Heredo sifilis 
muerte de la madre estudio 
neeropaico del feto — Med. de 
los ninos, Barcel., 1908, is, 80. 

Etienne, G. — Chancres syphilitiques 
doubles a periode d'incubation 
differente — Rev. med. de l'est, 
Nancy, 1905, xxxvii, 122. 

Ewald, P. — La syphilis a Haiti — 
France med., Paris, 1907, liv, 
191. 

Ewing, J. — Observations on spiro- 
chetal in syphilis — Proc. N. 
York Path. Soc, 1905-6, ns., v, 
105-114. 

Ewing, J. — Note on involution forms 
of spirochete pallida — Proc. N. 
York Path. Soc, 1907-8, ns. vii, 
166-171. 



Fabre et Bourret — Chancre syph- 
ilitique de la cuisse chez un 
nourrisson de trois mois — Bull. 
Soc. d'obst. de Paris, 1909, xii, 
155. 

Fabris, A. — Sulla epatite intersti- 
ziale diffusa nella sifilide ac- 
quisita— Arch, per le sc. med., 
Torino, 1908, sxx^il, 471-488, 
1 pi. 

Fabry, H. — Ueber extra-genitale 
syphilis — Ztschr. f. Bekampf. d. 
Geschlechtskrankh., L e i p z ., 
1908, viii, 180-190. 

Fagh, R. — The demonstration of 
spirochete sections — Kosp. Tid., 
Kobenh., 1907, 4 R. xv, 991, 
1019. 

Faivre — Infection surajoutee a la 
faveur de frottements et de de- 
fauts hy<;:eiiiqu?9 sur des ecti- 
dents plutot seeondaires que 
primitifs de la verge — Potou 
med., Poitiers, 1905, xix, 84. 

Falchi, F. — Contribu.ciuni alia pa- 
tologia fetale dell' occhio nella 
sifilide creditaria — lliv. ital. di 
ottal., Roma, 1905, i, 262. 

Falchi, F. — Contribn^ioni alia pa- 
tologia fetale dell' occhio nella 
sifilide ereditaria — Ann. di ot- 
tal., Pavia, 1905, xxxiv, 928. 



Fanoni, A. — A preliminary report 
upon the spirochehv of syphilis 
—Med. News, N. Y., 1905, 
Ixxxviii, 678. 

Fanoni, A. — La spirochete pallido 
nella sifilide — Riforrua med. 
Palermo-Napoli, 1905, xxi, 1361. 
1361. 

Fanoni, A. — The spirocheta pallida 
in syphilis — N. York M. J., 
1905, lxxxii, 944. 

Fantham, H. B. — The spirochetes; 
a review of some border-line or- 
ganisms between animals and 
plants — Science Prog. 20 cent., 
Lond., 1908-9, Hi, 148-161. 

Favento, P. — Di un caso di sifilide 
ereditaria — Gior. ital. d. mal 
ven., Milano, 1907, xlii, 513-517. 

Feldmann, H. — Spirocheta pallida 
in den organcn und im blute 
eines syphilitischen neugebor- 
enen — Ungar. med. Presse, Bu- 
dapest, 1906, xi, 28. 

Fellander, J. — Tertiar syfilis, ac- 
quirerad el er hereditar i hire 
kvi liga genitalia — All m. sven. 
Lakartidn., Stockholm, 1906, 
iii, 289-295. 

Fenoglietto, E. — L'ittero sifilitico . 
del periodo secondario contri- 
bute clinico — Rif orma med., 
Napoli, 1909, xxv, 1294-1303. 

Fere, C. et Tixier, G. — Etude sur la 
duree d'elimination rena e de 
l'iodure de potassium — Belgique 
med. Gand-Haarlem, 1906, xiii, 
195. 

Ferguson, J. — Inherited syphilis — 
Canada Lancet, Toronto, 1907- 
8, xli, 739-749. 

Fernet, G — ^lortalite par syphilis 
— Bull. Acad, de med., Paris, 
1907, 3 s. lviii, 586-595. 

Fernet, G. — Note sur les preserva- 
tifs de la syphilis a travers les 
ages — Ann. d. mal ven., Paris, 
1907, ii, 740. 

Fernet — Statistique sur la mortalite 
de la syphilis — Soc. franc, de 
la prohpyl. san. et mor. Bull., 
Paris, 1906, vi, 350. 

Ferre, H. — Recherches sur la pres- 
ence du spirochete de Schau- 
dinn dans les lesions superfici- 
elles de la syphilis — Compt. 
rend. Soc. de biol., Paris, 1906, 
lx, 97. 



322 



Recent Bibliography. 



Ferre, H. — De certaines infections 
secondaires d'origine buccale — 
Med. orient., Paris, 1906, x, 
417-421. 

Ferreira. C — Les cris incessants 
comme symptome de l'heredo- 
syphilis — Arch, de med. d. 
eivf.. Paris. 1909, xii, 369-372. 

Ferrua. J. — Sobre el origen precol- 
ombino de la sifllis — Gac. med. 
d. sur. de Espana, Granada, 

1907, xxv. 395-397. 

Feuillie, E. — Localisations du spi- 
rochete pallida chez un foetus 
heredo-syphilitique — Bull, et 
mem. Sue. med. d. Hop. de 
Paris, 1900, 3 s., xxiii, 275-278. 

Fiaschi, T. — Case of extensive syph- 
ilitic necrosis of the skull, il- 
lustrating an ea>y way for re- 
moving such sequestra — Aus- 
tralas. M. Gaz., Sydney, 1908, 
xxvii. 294. 

Ficai, G. — Su di un caso di sifilide 
necrossante e perforante della 
volt a cranica — Ceselpino 
Arezzo, L906, ii. 122-126. 

Kick. J. — Beitrag zur kenntnis der 
frischen Narbe nach eniem pa- 
pulotuberosen syphilid — 
Monatsh. f. prakt. Dermat.. 
Hamb., 1905. xl, 175. 1 pi. 

Fiessinger, C. — Les albuminuries 
syphilitiques — Rev. gen. de 
flin. et de therap., Paris, 1907, 
xxi. 485-4S7. 

Fieux et Mauriac, P. — Transmission 
mortelle au foetus d'une syph- 
ilis post-conceptionnelle tardive 
— Gaz. hebd. d. sc. med. de Bor- 
deaux. 1908, xxix. 442. 

Fieux et Mauriac, P. — Transmission 
mortelle au fcetus d'une syphilis 
post conceptionnelle tardive — 
Ann. do gvnee. et d'obst., Paris, 

1908. 2 s.'v.. 711-713. 

Finato, L. — Un caso di epitelioma 
associate a sifiloma — Clin. mod. 
Firenze, 1905, xi, 422. 

Finckh. J. — Die psychichen symp- 
tome bei lues — Centralbl. f. 
Nervenh. u. Psychiat., Berl., u. 
Leipz.. 1900. xxix. 865. 

Findlay. J. W. and Riddell, J. R — 
Gummatous synovitis of many 
joints closely simulating rheu- 
matoid arthritis in a congeni- 
tallv syphilitic child — Glasgow 
M. J.. 1906, xiv, 13. 



Finger, E. — Die neuere iitiologische 
und experimentelle syphilis- 
forschung — Wien med. Woch., 

1906. xlvii. 957-963. 

Finger, E. — Fortschritte in der 
luesforschung — 'Klin. therap. 
Wchschr., Wien. 1908, xv, 1329- 
1361. 

Finger, E. — Untersuchungen ueber 
syphilis an affen — Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz., 1906, lxxviii. 335-368, 
3 pi. 

Finger, E. u. Landsteiner, K. — Un- 
tersuchungen ueber syphilis an 
affen; 2 Mitteilung — Arch. f. 
Wissensch. Math, naturw. Kl., 
Wien. 1905. cxiv. 3. Abt., 497- 
538, 2 pi. 

Finger, E. u. Landsteiner, K. — Un- 
tersuchungen ueber syphilis an 
affen 2 Mitteilung — Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz.. 1900. lxxxi, 147-166. 

Finger. E. u. Landsteiner, K. — Un- 
tersuchungen ueber immunitat 
bei syphilis — Verhandl. d. 
deutsche dermat. Gesellsch., 
Berl.. 1907, 251-255. 

Finger, E. — Die neuesten errungen- 
schaften auf dem gebiete der 
syphilologie — Wien klin. Woch., 

1907. xxi. 1-7. 

Finger, E. — La syphilis et les mala- 
dies veneriennes — Rev. de 
therap. med-chir., Paris, 1909, 
lxxvi. 145-159. 

Finger, E. — Die zukunft der syphilis 
sex-probleme — Frankf. a. M., 
L909, v. 241-252. 

Fini. L. — Ulcera semplice o ulcera 
sifilitica diagnosi differenziale 
— Gazz. med. di Roma, 1906, 
xxxi. 421-424. 

Fiocco, G. B. — Ricerche ematolo- 
giche nella sifilide — Gior. ital. 
d. mal ven., Milano, 1906, xli, 
534. 

Fiocco, G. B. — Considerazioni in- 
torno al terziarismo richerche 
istologiche e parasitologiche — 
Riv. veneta di sc. med., Venezia, 

1908. xlix. 553-578, 2 pi. 
Fiorito, G. — Comma sifiilitica dello 

stomaco — Gazz. internaz. di 
med.. Napoli. 1909. xii. 251-253. 
Firth, R. H.— Yaws. In Syst. Med. 
(Allbutt) 80. Lond., 1907, ii, 
pt. 2. 695, 703. 



Recent Bibliography. 



323 



Fisch, C. — Spirochete pallida and 
syphilis — St. Louis M. Rev., 
1907, lv, 374. 

Fisehel, W. — A case of tertiary 
syphilis which resembled in its 
course and symptoms phthisis 
pulmonalis — Med. Fortnightly, 
St. Louis, 1906, xxix, 331-336. 

Fischer, W. — Ueber die diagnostis- 
chen und therapeutischen ergen- 
nisse der neuesten syphilis- 
forschung — Therap. d. Gegenw., 
Berl., 1907, xlviii, 71. 

Fischer, W. — Die neuesten f or- 
schungen den erreger des syph- 
ilis — Berl. Klinik, 1907, xix, 
Hft. 223, 1-20. 

Fischer, W. u. Meier, G. — Ueber den 
klinischen wert der Wasser- 
mannschen serodiagnostik bei 
syphilis — Deutsche med. Woeh., 
Leipz., u. Berl., 1907, xxxiii, 
2169-2172. 

Fischer, W. — Die bewertung der 
Wassermannschen reaktion filr 
die friihdiagnose und die thera- 
pie der syphilis — Med. Klin., 
Berl., 1909, v, 173-175. 

Fischer, W. — Klinische betracht- 
ungen ueber die Wassermann- 
sche reaktion bei syphilis — 
Berl. klin. Woch., 1908, xlv, 
151-153. 

Fischkin, L. A. — The elements of 
diagnosis of cutaneous syphilis 
— J. Am. M. Ass., Chicago, 
1905, xlv, 95. 

Fitzgerald, J. G. — The significance 
of spirocheta pallida in syph- 
ilis — Canad. Pract. and Rev., 
Toronto, 1906, xxxi, 1-4. 

Fitzwilliams, D. C. L. — Case of con- 
genital syphilis showing wide- 
spread periostitis of the long 
bones — Proc. Roy. Soc. Med., 
Lond., 1908-9, ii, sect. stud. Dis. 
child., 21. 

Fitzwilliams, D. C. C. — A case of 
hereditary syphilis showing 
marked changes in the long 
bones— West Lond. M. J., 1909, 
xiv, 32. 

Fleisehmann, P. and Butler, W. J. 
— Serum diagnosis of syphilis — 
J. Am. M. Ass., Chicago, 1907, 
xlix, 9S4-938. 

Fleisehmann, P. — Die theorie, praxis 
und resultate der serum diag- 
nostik der syphilis — Dermat. 
Centralbl., Leipz., 1908, xi, 
226, 258. 



Fleisehmann — Zur theorie und 
praxis der serumdiagnose der 
syphilis — Berl. klin. Woch., 

1908, xlv, 490-494. 
Fleisehmann — Zur theorie und 

praxis der serumdiagnose der 
syphilis — Verhandl. d. Berl. 
med. gesellsch (1908), 1909, 
xxxix, 2 teil, 70-91; Discussion, 
1 teil, 115. 

Fleming, A. — A simple method of 
serum diagnosis of syphilis — 
Lancet, Lond., 1909, 'i, 1512- 
1515. 

Fleming, A. — Demonstration of a 
simple method of serum diag- 
nosis of syphilis by the "com- 
plement deviation" method — 
Proc. Roy. Soc. Med., Lond., 
1908-9, ii, Clin. Sect., 220-225. 

Fleming, A. — The serum diagnosis 
of syphilis — Brit. M. J., Lond., 

1909, ii, 984. 

Flesch, A. and Schossbeger, S. — 
Leukemic changes of the blood 
in congenital syphilis and sep- 
sis — Orvosi hetil, Budapest, 
1907, li, 306. 

Flesch, H. u. Schossberger, A. — ■ 
Leukamische blutveriinderung 
bei lues congenita und sepsis — 
Deutsche med. Woch., Leipz. u. 
Berl.. 1907, xxxiii, 1090. 

Flexner, L. — The etiology of syph- 
ilis— Med. News, N. Y., 1905, 
lxxxvii, 1105-1114. 

Flexner, S. and Noguchi, H. — On 
the occurrance of spirocheta 
pallida Schaudinn in syphilis — 
Med. News, N. Y., lxxxvi, 1145. 

Flexner, S. — Spirocheta ( trepo- 
nema) pallida and syphilis — J. 
Exper. M., N. Y., ' 1907, ix, 
464-472, 1 pi. 

Flexner, S. — Demonstration of tre- 
ponema pallidum, with the 
dark-field illumination micro- 
scope — Proc. N. York Path. 
Soc, 1907-8, ns. vii, 207-210. 

Florance — Beitrag zur frage tatowi- 
erung und syphilis — Dermat. 
Ztsehr.. Berl., 1909, xvi, 783- 
785. 

Florito, G. — Le reazioni di Justus 
Farnowsky e de Wassermann 
nella sifilide — Gior. internaz. di 
med., Napoli, 1909. xii, 97-109. 

Flugel, K. — Weitere spirochetenbe- 
funde bei syphilis — Deutsche 
med. Woch., Leipz. u. Berl., 
1905, xxxi, 1755. 



324 



Recent Bibliography. 



Follett, L. — Examen clinique de la 
salive des syphilitiques — 
Compt. rend. Soc. de biol., 
Paris, 1907, lxii, 667. 

Fontana, A. — Contribuzione alio 
studio della sifilide corneale 
del coniglio — Rig. d'igi. e san. 
pubb., Torino, 1907, xviii, 646- 
655. 

Foote, C. G. — A report of some un- 
usual cases of syphilis — Ohio 
M. J., Columbus^ 1907-8 ii, 
271-273. 

Foquet, C. et Brin— De la syphilis 
acquise chez les heredo-syphili- 
tiques — J. de med., int. Paris, 
1909, xiii, 271-273. 

Forconi, G. — Su di un caso atipieo 
di sifilide papulo-squamosa 
(psoriasi sifilitiea) nota elinica 
— Atti. d. r. accad. d. fisiocrit. 
in Siena, 1909, 5 s. i, 119-122. 

Fordyce, J. A. — A case of luetic in- 
fection with symmetrical 
cutaneous atrophy— Internat. 
Dermat. Cong. Tr., N. Y., 1908, 
i, 165. 

Fordyce, J. A. — Some observations 
on syphilis— N. York State J. 
M., N. Y., 1908, viii. 451-458. 

Fordyce, J. A. — Some observations 
on syphilis — Oklahoma M. 
News-Jour.. Okla. City, 1909, 
xvii, 671-686. 

Fordyce. J. A. — The vessel changes 
and other histologic features of 
cutaneous syphilis — Jour. Am. 
M. Ass., Chicago, 1907, xlix 
462. 

Forest, M.— Beitrag zur morpholo- 
gic der spirochete pallida (Tre- 
ponema pallidum Schaudinn) — 
Centralbl. f. Bakteriol., 1 Abt., 
Jena, 1906, xli. 608, 1 pi. 

Forgue et Jeanbrau — La syphilis 
devant la loi sur les accidents — 
Montpel. med.. 1908 xxvii 49- 
55. 

Fornet — A practical description of 
the various methods employed 
in the sero-diagnosis of syphilis 
— Med. Press and Circ. Lond., 
1908. ns. Ixxxvi, 138-140. 

Fornet — Technique de divers pro- 
cedes employes pour le sero- 
diagnostic de la syphilis — Se- 
maine med., Paris, i908, xxviii, 
217-219. 
Fornet. W.— Die Wassermann — A. 
Aeisser— Bruck'sche reaktion bei 



syphilis — Deutsche med. Woch., 
Leipz. u. Berl., 1908, xxxiv,' 
830. 
Foms — Sifilis terciaria del velo pal- 
atino — Rev. espec. med., Ma- 
drid, 1907, x, 149. 
Foster, B.— Syphilis — J. Minn. M. 
Ass., Minneap., 1907, xxvii, 413- 
416. 
Fouquet, C— Presence du spiro- 
chete pale de Schaudinn dans 
le testicule d'un nouveau-ne 
herero-syphilitique — Compt. 
rend. Accad. d. sc. Paris, 1906, 
cxliii, 792. 
Fouquet, C— Etude anatomo-patho- 
logique et micro-biologique de 
quatre foetus heredo-syphilit- 
iques— Bull. Soc. d'obst, Paris 
1907, x, 6-19. 
Fouquet, C— Sur une forme aty- 
pique rectiligne du spirochete 
pale de Schaudinn desembodies 
microbiennes dans la syphilis 
et de leur role dans la produc- 
tion des gommes — Ann. d. mal 
ven.. Paris, 1907, ii, 256 
Fouquet. C— Etude sur la syphilis 
hereditaire du fois— Ann.'d. mal 
ven., Paris, 1907, ii, 481 593, 
667, 830. 
Fouquet, C. — Sur une forme rec- 
tiligiie du spirochete pale sa 
signification son role probable 
dans les lesions tertiaires — 
Compt. rend. Soc. de Biol 
Paris, 1907, lxii, 225. 
Fouquet, C— Presence de trepo- 
nemes pales de Schaudinn dans 
1-appendice d'un foetus heredo- 
syphilitique — Compt. rend. 
Acad. d. sc, Paris, 1907, cxlv 
1309. 
Fouquet. C— Note sur la presence 
de treponemes pales de Schaud- 
inn dans l'appendice d'un foetus 
heredo-syphilitique — Ann. d. 
mal. ven.. Paris, 1908, i, 38. 
Fouquet, C. — Le treponeme pale de 
la syphilis ses localisations — 
Gaz. d. hop., Paris. 1908, lxxxi, 
435-441. 
Fouquet, C— Dermatologie et syph- 
ilographie — Medeein prat., 
Paris, 1908, iv, 728. 
Fouquet. C. — Le diagnostic de la 
syphilis par les methodes nouv- 
elles — J. de med. int., Paris, 
1909, xiii. 35. 



Recent Bibliography. 



325 



Fournier, A. — La contagion de la 
syphilis perles verres — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1909, xx, 2-4. 

Fournier, E. — Les stigmates de 
l'heredo-syphilis de seconde gen- 
eration — Med. mod., Paris, 

1905, xvi, 121. 

Fournier, E. — Dystrophies du sys- 
teme veineux dans l'heredo- 
syphilis — Bull. Acad, de med., 
Paris, 1907, 3 s. lviii, 385-389. 

Fournier, E. — In welchem alter in- 
fiziert man sich — Med. f. Alle, 
Wien u. Leipz., 1907, ii, 220- 
222. 

Fournier, E. — In welchem alter in- 
flziert man sich — Med. f. Alle, 
Wien u. Leipz., 1907, ii, 236, 
248. 

Fournier, A. — A propos des syph- 
iloides papillomateuses — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 109. 

Fournier, A. — La syphilis des bon- 
netes femmes — Bull. Acad, de 
med., Paris, 1906, 3 s. lvi, 190- 
232. 

Fournier, A. — Syphilis secondaire 
tardive — Syphilis, Paris, 1906, 
iv, 243-263. 

Fournier, A. — La syphilis secondaire 
tardive. ( Abstr ) — Bev. de 
therap. med. chir., Paris, 1906, 
Ixxiii, 145-154. 

Fournier, A. — Onychomalacie syph- 
ilitique — Ann. d. mal ven., 
Paris, 1906, i, 161-168. 

Fournier, A. — Die syphilis der uns- 
chuldigen— Med. f. Alle, Wien 
u. Leipz., 1906, i, 158, 175, 208, 
219, 233, 244, 256. 

Fournier — Ein fall von syphilisin- 
jektion einer ganzen familie 
durch eine amme — Med. f. Alle, 
Wien, 1906, i, 4-6. 

Fournier — Zungenkrebs syphilis und 
tabak — Wien med. Presse, 1907, 
xlviii, 1775-1778. 

Fox, H. — A case of syphilis resem- 
bling rubra pilaris — J. Am. M. 
Ass., Chicago, 1909, liii, 947. 

Fox, H. — A comparison of the Was- 
sermann and Noguchi comple- 
ment fixation tests — J. Cutan. 
Dis. inch Syph., N. Y., 1909, 
xxvii, 338-351. 

Fox, H. — Palmar syphilide — J. Cu- 
tan. Dis. incl. Syph., N. Y., 

1906, xxiv, 476. 



Fox, G. F. — The principles and tech- 
nic of the serum diagnosis of 
syphilis — Am. Med., Burling- 
ton, Vt., and N. Y., 1909, ns. 
iv, 152-154. 

Fox, H. — Some observations upon 
the structure of spirocheta pal- 
lida (bchaudinn) — Univ. Penn. 
M. Bull., Phila., 1906-7, xix, 
266. 

Fox, H. — Case of hereditary syphilis 
— J. Cutan. Dis. incl. Syph., N. 
Y., 1908, xxxvi, 39. 

Fox, H. — Syphilis of the lip— J. 
Cutan. Dis. incl. Syph., N. Y., 
1909, xxvii, 178. 

Fox, H. — The principles and tech- 
nique of the Wassermann reac- 
tion and its modifications — 
Med. Rec, N. Y., 1909, lxxv, 
421-428. 

Fraenkel, C. — Ueber das vorkommen 
der spirochaetse pallida bei syph- 
ilis — Munchen med. Woch., 
1905, Hi, 1129. 

Fraenkel, E. u. Much, H. — Die Was- 
sermannsche reaktion an der 
1 e i c h e — Munchen med. 
Wchnschr., 1908, Iv, 2479-2484. 

Fraenkel, E. u. Much, H. — Ueber 
die Wassermannsche serodiag- 
nostik der syphilis — Munchen 
med. Woch., 1908, Iv, 602. 

Franceschini, G. — Ancora a propo- 
sito della contagiosita delle 
manifestazioni terziarie della 
sifilide — Gior. ital. d. mal ven., 
Milano, 1906, xli, 247. 

Franceschini, G. — Contribute alia 
classificazione e alia sintomato- 
logia della sifilide del sistema 
riproduttore nella donna — 
Gazz. d. osp., Milano, 1909, xxx, 
537-540. 

Franceschini, J. — 'Contribution a la 
classification et a la sympto- 
matologie de la syphilis du sys- 
teme reproducteur chez la 
femme — Ann. d. mal. ven., 
Paris, 1909,, iv, 241-246. 

Francois, Dainville — Deux cas de 
paralysie faciale chez deux con- 
joints, au cours de la syphilis 
secondaire — Bull. Soc. franc, 
de dermat. et syph., Paris, 1906, 
xvii, 155-157. 

Francois, P. — Le microbe de la syph- 
ilis spirochaete pallida de 
Schaudinn et Hoffmann — Ann. 
Soc. de med. d'Anvers, 1905, 
lxvii, 107. 



326 



Recent Bibliography. 



Frankel, E. — Ueber eine fall von 
angeborener Dunndarm-syphilis 
nebst benierkungen ueber die 
atiologische bedeutung der spir- 
ochete pallida — Miinchen med. 
Wcbnsclir.; Ann. d. mel. ven., 
Paris, 1907. ii, 605, 607. 
French, H. C— Malignant syphilis 
— J. Roy. Army Med. Corps, 
Lond., 1905, iv, 477-487. 
French, H. C. — True rupia in syph- 
ilis — J. Roy. Army Med. Corps, 
Lond., 1908, x, 296. 
Frenkel, I. A. — Diagnosis of syphilis 
in connection with Wasser- 
mann's reaction — Russk. J. 
kozhn. i. ven. boliezn. Kharkov, 
1909, xvii. 191-198. 
Freshwater, D. — Case of syphilis 
secondaire tardive (Fournier) 
— Proc. Roy. Soc. Med., Lond., 
1908-9, ii, Dermat. Sect., 72. 
Freund, R. — Ueber cytorrhyctes Iuis 
siegel— Miinch. ' med." Woch.. 
1905. Bd. lii. s. 1819. 
Frick, W. — Some unusual syphilitic 
eruptions — J. Kansas M. Soc, 
Lawrence. 1905, v. 51. 
Frick. \V. — Extra-genital primary 
syphilis; report of some un- 
published cases — Am. J. Der- 
mat and Genito-Urin. Dis., St. 
Louis, 1908, xii, 18-20. 
Frick. \V.— Extra-genital primary 
syphilis: report of some unpub- 
lished cases — Kansas City M. 
Index-Lancet, 1908, xxxi, 81-83. 
Friedenthal, H.— Ueber Bpirochteten- 
befunde bei carcinom und bei 
syphilis — Berl. klin. Woch 
1906, xliii. 1216-1218. 
Friedjung, J. K.— Paroxysmale 
hamoglobinurie bei hereditarer 
lues— Mitt. d. gesellsch. f. inn. 
med. u. kinderh. in Wien 
1908, viii, 21. 
Friend, W. M. — Hereditary svphilis 
— Med. Times, N. Y., 1908, 
xxxvii. 303. 
Friendenthal. H — \Yelehe gewebe- 
standteile in entzundeten ge- 
webe tauschen silberspirocha>ten 
vor?— Berl. klin. Woch., 1907. 
xliv, 99. 
Fritz, W. u. Kren, 0,— Ueber den 
wert der serumreaktion bei 
syphilis nach Porges. Meier und 
Elausner — Wien klin. Woch., 
1908, xxi. 386-388. 



Frohivein, F. — Spiroclwetenbefunde 
im gewebe — Med. Klin., Berl., 
1906, ii, 439-442. 
Froloff, P. I. — Considerable gumma- 
tous deformities of the bones of 
the face and skull in a heredi- 
tary syphilitic — Russk. J. 
kozhn. i. ven. boliezn, Kharkov 
1905, ix, 42. 
Froment — Chancre indure du nez — 

Lyon med., 1908, cxi, 778. 
Fruhwald, R.—Ueber den nachweis 
der spirochaite pallida mittelst 
des tuscheverfahrens — Miinchen 
med. Woch., 1909, lvi, 2523- 
2524. 
Fuchs, E.— Malformation of the 
cornea in cases of inherited 
syphilis — Ophth. Rev., Lond., 
1909, xxviii, 247-250. 
Fullerton. R. — Remarks on syphilis 
of the upper respiratorv pas- 
sages—Glasgow M. J., 1906, lxv, 
247-253. 
Furesz, E. — Ueber die beziehungen 
der spirochete pallida zu der 
antiluetischen Kur — Med. Klin., 
Berl., 1907, Hi, 1045. 
Furstenberg, A. u. Trebing, J.— Die 
luesreaktion in ihren bezie- 
hungen zur anti-tryptischen 
kraft des menschliehen blutes — 
Berl. klin. Woch., 1909, xlvi, 
1357-1359. 
Fusco, G. — Su alcuni caratteri mor- 
fologici e sulla colorazione 
dello spirochete pallido — N. riv. 
clin. terap.. Napoli. 1906, ix, 
74-81. 



G-, C. — El bacilo de la sifilis — Ju- 
ventud med.. Guatemala, 1905, 
vii, 41-43. 

Gailleton — Diagnostic de la syphilis 
au moment de la naissance — 
Ann. de med. et chir. inf., 
Paris. 1905. ix. 235-241. 

Galambos, A. — Ueber den wert der 
farbenreaktion bei lues — 
Deutsche med. Woch., Leipz. u. 
Berl., 1909, xxxv. 976. 

Galezowski, J. et Valli, 0.— Retinite 
syphilitique centrale heredo- 
syphmuque — Rec. d'ophth., 
Paris, 3 s. xxx, 429-43S. 

Gallardo, J. S. — Aigunas investiga- 
ciones acerca de la etiologia de 
la sifilis— Rev. med. de Sevilla 
1909, lii, 108, 170, 205. 



Recent Bibliography. 



327 



Gallavardin, L. et Rebattu, J. — 
Syndrome cerebelleux complet 
avec oedeme papillaire ayant 
disparu sous rinfluence du 
traitement iodure — Lyon med., 
1909, exii, 281-287. 

Galli, G. — Un caso di sifilide cere- 
brate con emiplegia sinistra 
guarito colle iniezioni endove- 
nose d'idrargirio — Policlin., 
Roma, 1906, xiii, sez. prat., 257- 
260. 

Galli-Valerio et Lassuer, A. — Sur la 
presence de spirochetes dans les 
lesions syphilitiques — Rev. med. 
de la Suisse Rom., Geneve, 
1905, xxv, 487-494. 

Galli, G. — Sifilide neurastenia ed 
arteriosclerosi — Riforma med., 
Napoli, 19o6, xxiv, 421-425. 

Gallia, C. — Di un caso di sifilide pso- 
riasiforme — Gazz. d. osp. Mi- 
lano, 1906, xxvii, 1099. 

Gallois, P. — Heredo-syphilis et 
scrofule — Bull. med., Paris, 
1905, xix, 315. 

Gamble, R. A. — Syphilis — Virginia 
M. Semi-Mont., Richmond, 1905, 
x, 538-545. 

Gangi, S. — Contribute alio studio 
dei disturbi nervosi nei sifil- 
itici — Gior. di med. mil., Roma, 
1909, lvii, 23-32. 

Ganjoux, B. — Heredo-syphilis a 
manifestations viscerales- multi- 
ples en particulier avec lesion 
des surrenales et hypertrophic 
du pylore chez un nourrisson-ne 
d'une mere saine en appearance 
et allaite par elle — Bull. soc. de 
pediat. de Paris, 1909, xi, 282- 
291. 

Ganjoux, E., Bosc. E. et Brunei — 
Poie silex de l'heredo-syphilis — 
Montpel. med., 1909, xxviii, 397. 

Gantz, M. — Ein fall von spontanet 
luetischer trachealfistel — 
Monatschr. f. Ohrenheilk., Berl., 
1907, xli, 721-725. 

Ganzer, H. — Ueber spirochseten im 
munde — Berl. tierarztl. Woch., 
1905, 808. 

Garabaldi, G. — Le alterazioni che 
subiscono gli strati cutanei 
sussidiat del dartos per condi- 
zioni teratologiche e sifilide — 
Clin, dermosifilopat. d. r. Univ. 
di Roma, 1909, xxvii, 119-124. 

Garcia, P. J. — Spirochete pallida 
Schaudinni — Rev. d. centro 



estud de med., Buenos Aires, 
1905, iv, 241. 

Garcia, de Quevedo, L. — Etiologia 
de la sifilis con experiencias 
sobre la spirochsete pallida — 
Bol. Assoc, med. de Puerto- 
Rico, San Juan, P. R., 1906, iv, 
88-91. 

Garel, J. — Heredo-syphilis, localisa- 
tion au pharynx et au larynx 
chez une ftllette de 9 ans; re- 
marques sur la valeur comparee 
de l'iodure et du mereure — 
Lyon med., 1906, cvi, 638-642. 

Garipuy, E. — Leucoplasie buccale et 
retinite syphilitiques — Toulouse 
med., 1906, 2 s. viii, 195-197. 

Gassmann, A. — Les bubons ramollis 
idiopathiques de la syphilis re- 
cente — Rev. de med. de la 
Suisse Rom., Geneve, 1905, xxv, 
811-821. 

Gastinel, P. — Trois cas de chancre 
simple de la verge avec lymph- 
angite abcedee et chancrellisa- 
tion secondaire des reguments — 
Ann. de dermat. et syph., Paris, 
1909, 4s. x, 116-118. 

Gasteu et Commandon — Preuve don- 
nee par l'ultra-microscope de la 
contagion possible de la syphilis 
par les verres a boire— Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1908, xix, 292-294. 

Gasteu — Nouveaux proeedes rapides 
de recherches du spirochete 
dans les frotti; procede a Far- 
gent de Commandon procede dif- 
ferentiel de Bottelli — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1908, xix, 294-298. 

Gaston et Photinos — Syphilides fa- 
ciales et perianales chez un en- 
fant piesentant des dystrophies 
craniennes de nature heredo- 
syphilitique — Bull. Soc. franc, 
de dermat. et syph., Paris, 1905, 
xvi, 112. 

Gaston, P. L. — La syphilis heredi- 
taire et l'heredite syphilitique — 
Ann. de med. et chir. inf., 
Paris, 1906, x, 385-392. 

Gaston, P. — La syphilis hereditaire 
et l'heredite syphilitique — Gaz. 
d. Hop., Paris,' 1906, lxxix, 699- 
701. 

Gastou, P. — Diagnostic de la syph- 
ilis par Fultramicroscope — 
Presse med., Paris, 1908, xvi, 
237-239. 



328 



Recent Bibliography. 



Gaston et Legendre, L.— Syphilome 
en cuirasse datant de 19 aus, 
developpe sur un eczema se- 
borrheique presternal — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1907, xviii, 362-366. 

Gaston et Legendre, L. — Dystrophies 
hereditaires et malformations 
congenitales eonstituant un en- 
semble de stigmates heredo- 
syphilitiques a heredite toxi- 
infectieuse complexe — Bull. Soc. 
franc, de dermat. et syph., 
Paris. 1908. xix, 191-193. 

Gaston. P. et Girauld — La syphilis 
hereditaire congenitale et la 
maceration foetale — Ann. d. 
mal. ven., Paris, 1908, iii, 274- 
290. 

Gastou et Girauld — Frequence du 
treponeme hepatique chez le 
foetus macere et syphilis con- 
genitale — Bull. Soc. franc, de 
dermat. et syph., Paris, 1908, 
xix, 62-65. 

Gastou et Girauld — Presence du 
spirochete pale de Schaudinn 
dans le reticulum conjonctivo- 
elastique d'une gomme hepat 
ique chez un heredo-syphilitique 
— Bull. soc. d'obst. de Paris. 
1909, xii, 127-129. 

Gaston et Commandon — I/ultra-mi- 
croscope et son role essentiel 
dans le diagnostic do la syphilis 
— J. rued, franc, Paris, 1909. 
ii. 218-225, incl. 4 pi. 

Gastou et Commandon — L'ultra-mi- 
croscope et son role essentiel 
dans le diagnostic de la syphilis 
— Bull, et mem. soc. med. d. 
hop., Paris, 1909, 3s. xxvi, 528- 
536. 

Gaucher et Louste. A. — Syphilides 
graunleuses miliaires resemb- 
lant a la keratose piliare — Bull. 
Soc. franc, de dermat. et syph., 
Paris. 1905, xvi, 77. 

Gaucher et Louste, A. — Chancre 
phagedenique du fourreau 
gommes periostiques du crane — 
Bull. Soc. franc, de dermat. et 
syph., Paris. 1905, xvi, 128. 

Gaucher et Mnnier-Vinard — Conta- 
gion syphilitique par un ban- 
dage herniaire, syphilide uleero- 
crustacee generalisee secondaire 
neconnue pendant trois mois — 
Bull. Soc. franc, de dermat. et 
syph., Paris. 1907, xviii, 118. 



Gaucher et Louste — Doux cas de 

syphilis hereditaire simulant la 

tubereulose — Bull. Soc. franc. 

de dermat. et syph., Paris, 

- 1905, xvi, 156. 

Gaudier et Louste — Syphilis heredi- 
taire dystrophic achondroplasie 
insuffisance intellectuelle — Bull. 
Soc. franc, de dermatol. et 
syph., Paris, 1905, xvi, 159. 

Gaucher, Paris et Claude, O. — Chan- 
cre de la region preternale — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1905, xvi, 183. 

Gaucher et Boisseau — Tertiarisme 
precoce (gommes de la verge et 
du pharynx trois mois apres le 
chancre) — Bull. soc. franc, de 
dermat. et svph., Paris, 1905, 
xvi. 316. 

Gaucher — La syphilis hereditaire 
tertiaire diagnostic — J. de med. 
int., Paris, 1905, ix, 156. 

Gaucher — Lesions cutanees sous-cu- 
tanees ganglionnaires et mus- 
culaires de l'heredo-tertiaire de 
l'heredo-syphilis — J. de med. 
int.. Paris, 1905, ix, 206. 

Gaucher — Gommes bucco-pharyngees 
de la syphilis hereditaire — J. de 
med. int., Paris, 1905, ix, 315. 

Gaucher — Lesions cutanees-tertiaires 
de l'heredo-syphilis — Med. mod., 
Paris, 1905, tome xvi, 249. 

Gaucher — La syphilis hereditaire — 
Arch, de med. et chir. spec, 
Paris, 1904, v, 245, 275, 305, 
335. 365—1905, vi. 1. 

Gaucher et Touchard — Phlebites 
multiples au cours de la syph- 
ilis secondaire — J. de mal. cu- 
tan. et syph., Paris, 1905, xvii, 
189. 

Gaucher et Louste — Deux cas de 
syphilis hereditaire simulant la 
tubereulose — Jour. d. mal 
cutan. et syph., Paris, 1905, 
tome xvii, 428-431. 

Gaucher — Syphilide du cou — Syph- 
ilis, Paris. 1905, iii, 804. 

Gaucher — Syphilides papuleuses gen- 
eralisees — Syphilis, Paris, 1905, 
iii, 810. 

Gaucher — Chancre du mamelon chez 
une nourrice contagion par 
nourrisson — Syphilis, Pari3, 
1905, iii, 810-812. 

Gaucher — Deux cas de syphilis ter- 
tiare grave neconnue — Syphilis, 
Paris, 1905, iii, 814. 



Recent Bibliography. 



329 



Gaucher — Gomme chancriforme — 
Syphilis, Paris, 1905, 813. 

Gaucher — Ictere chez une syphilit- 
ique — Syphilis, Paris, 1905, iii, 
816. 

Gaucher — Syphilis maligne — Syph- 
ilis, Paris, 1905, iii, 817. 

Gaucher — Gommes multiples chez 
une strumeuse — Syphilis, Paris, 
1905, iii, 824. 

Gaucher — Syphilides granuleuses 
milliaires — Syphilis, Paris, 

1905, iii, 828. 

Gaucher — Spina ventosa heredo- 
syphilitique — J. de med. int., 
Paris, 1906, x, 190. 

Gaucher — Les osteites epiphysaires 
et les arthopathies tertiaires de 
l'heredo-syphilis — J. de med. 
int., Paris, 1906, x, 191. 

Gaucher — Enseignement de la syph- 
iligraphie — Syphilis, Paris, 

1906, iv, 321-349. 

Gaucher et Boisseau — Chancre syph- 
ilitique du vestibule urinaire — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1906, xvii, 183. 

Gaucher et Malloizel — Ulceration 
linguale chez une enfant de 11 
ans; syphilis acquise datant de 
deux ans — Bull. Soc. franc, de 
dermat. u. syph., Paris, 1906, 
xvii, 296. 

Gaucher et Malloizel — Perforation 
gommeuse heredo-syphilitique 
du voile du palais chez une 
jeune fille vierge de 15 ans — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1906, xvii, 296. 

Gaucher et Monier-Vinard — Gommes 
syphilitiques du muscle sterno- 
eleido-mastoiden ( syphilis ac- 
quise) — Bull. Soc. franc, de 
dermat. et syph., Paris, 1906, 
xvii, 433. 

Gaucher — Pathogenie des pigmenta- 
tions du cou dans la syphilis— 
Gaz. d. hop., Paris, 1906, lxxix, 
759-763. 

Gaucher et Camus, P. — Chancre 
syphilitique de la fosse navicu- 
laire de l'urethre — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 317. 

Gaucher — Exception a la loi de 
Colles Baumes, contamination 
d'une mere par son enfant 
heredo-syphilitique — Bull. Soc. 
franc, de dermat. et syph., 
Paris, xviii, 404-406. 



Gaucher — Les osteites suppurees et 
les osteo-arthrites de l'heredo- 
syphilis tertiaire — Ann. d. mal 
ven., Paris, 1906, i, 3-21. 

Gaucher et Monier-Vinard — Syph- 
ilides tertiaires ulcero-crout- 
euses des marines gomme de la 
voute palatine syphilome diffus 
du voile et des piliers keratite 
interstitielle chez un heredo- 
syphilitique — Bull. Soc. franc, 
de dermat. et syph., Paris, 1907, 
xviii, 120. 

Gaucher, Fouquet et Grehant — Ob- 
servation d'un nouveau cas 
d'osteite syphilitique tertiaire 
suppuree du tiers inferieur du 
femur avec arthropathia, simu- 
lant une lesion tuberculeuse — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1907, xviii, 315. 

Gaucher, Camus, P. et Druelle — 
Chancre syphilitique de la gen- 
cive — Bull. Soc. franc, de der- 
mat. et syph., Paris, 1907, xviii, 
316. 

Gaucher et Boty — Chancre syph- 
ilitic du thorax — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 403. 

Gaucher et Lacapere — Syphilis et 
diabete — Ann. d. mal ven., 
Paris, 1907, ii, 357-368. 

Gaucher — L'heredo-syphilis quater- 
naire du tissu reticule (appen- 
dicite, vegetations adenoides et 
serofule) — Ann. d. mal ven., 
Paris, 1907, ii, 656-666. 

Gaucher — Sifilis terciaria del velo 
palatino — Rev. espec. med., Ma- 
drid, 1907, x, 149. 

Gaucher — L'heredite syphilitique de 
la seconde generation heredite 
toxinique heredite virulente im- 
munisation — J. de med. int., 
Paris, 1907, xi, 289-291. 

Gaucher et Levy-Bing — Des osteop- 
athies de l'heredo-syphilis quat- 
ernaire — Ann. d. mal. ven., 
Paris, 1908, iii, 22-30. 

Gaucher et Camus, P. — Plaques 
muquesuses tardives — Ann. d. 
mal. ven., Paris, 1908, i, 31-35. 

Gaucher et Nathan — Un cas des 
chancres successifs — Ann. d. 
mal. ven., Paris, 1908, iii, 362- 
366. 

Gaucher — Chancre de la langue — J. 
de med. de Paris, 1909, 2 s. xxi, 
323. 



330 



Recent Bibliography. 



Gaudier et Glover — Surdite centrale 
bilaterale heredo-syphilitique de 
seconde generation — Ann. d. 
mal. ven., Paris, 1908, iii, 134- 
137. 

Gaucher et Giroux — Chancre syph- 
ilitique de la pituitaire — Ann. 
d. mal. yen., Paris. 1908, iii, 
693. 

Gaucher et Nathan — Chancre de 
l'amygdale de la cloison a 
gauche plaque muqueuse flssur- 
ique de la main droite — Bull. 
Soc. franc, de dermat. et svph., 
Paris, 1908, six, 29. 

Gaucher et Nathan — Manifestations 
tertiaires de syphilis acquise 
chez line heredo-syphilitique 
dystrophique — Bull. Soc. franc, 
de dermat. et svph., Paris, 1908, 
.xix, 30. 

Gaucher et Bory — Plaques muqueuses 
vegetantes de l'aiselle — Bull. 
Soc. franc, de dermat. et svph., 
Paris, 1908, xix, 56. 

Gaucher et Bory — Gomme suppuree 
du bord palpebral inferieur 
gauche six mois apres le chan- 
cre — Bull. Soc. franc, de der- 
mat. et svph., Paris, 1908, xix, 
56. 

Gaucher et Bory — Heredo-sypbilide 
tertiaire papulo-squameuse cir- 
cinee — Bull. Soc. franc, de der- 
mat. et svph., Paris. 190S. xix. 
155-15S. 

Gaucher et Louste — Chancre syph- 
ilitique du capuchon chez une 
enfant de huit ans contagion 
familiale — Bull. Soc. franc, de 
dermat. et svph.. Paris. 1908. 
xix. 160. 

Gaucher et Abrami — Heredo-syphilis 
tertiaire osseuse et cutanee sup- 
puree — Bull. Soc. franc, de der- 
mat. et svph.. Paris, 1908. xix. 
190. 

Gaucher et Abrami — Ulceres gom- 
meux chez une variquese — Bull. 
Soc. franc, de dermat. et svph., 
Paris, 1908. xix. 210. 

Gaucher and Levy-Bing — Osteopa- 
thies of quaternary syphilis — J. 
Cutan. Dis. incl. Svph., N. Y., 
1908. xxvi, 1-6. 

Gaucher et Levy-Bing — Les osteo- 
pathies de l'heredo-syphilis 
quaternaire — Internat. Dermat. 
Cong., 1907, Tr.. N. Y., 1908. 
ii. 801-808. 



Gaucher — Le chancre syphilitique — 
Rev. Internat. de med. et chir., 
Paris, 1908. xix, 361-363. 

Gaucher, E. et Merle, P. — Chancre 
geant cicatrise sous-pubien — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1909, xx, 35. 

Gaucher, E. et Merle, P. — Constata- 
tion du treponema pallidum 
dans le liquide cephalo-rachidien 
au cours de la syphilis acquise 
des centres nerveux — Compt. 
rend. soc. acad. d. sc, Paris, 
1909, cxlviii, 862. 

Gaucher, E. et Druelle — Syphilome 
tertiaire de I'uretre — Bull. Soc. 
franc, de dermat. et svph., 
Paris. L909, xx, 122. 

Gaucher. E. et Druelle — Chancre de 
Tangle interne de l'oeil — Bull. 
Soc. franc, de dermat. et svph., 
1909, xx, 123. 

Gaucher — L'heredo-syphilis quater- 
naire du tissu reticule (appen- 
dicite) ; vegetations adenoides 
et scrofule — internat. Dermat. 
Cong.. 1907, N. Y., 1908, ii, 
777-7!Mi. 

Gaucher et Giroux — Heredo-syphilis 
tertiare avec ulceration de la 
jambe gauche glossite exfolia- 
trice — Bull. Soc. franc, de der- 
mat. et svph., Paris, 1908. xix, 
336. 

Gaucher et Giroux — Note prelimi- 
naire sur l'ictere hiimolytique 
de la Byphilis secondaire — Ann. 
d. mal. ven.. Paris, 1909, iv, 
481. 

Gaucher et Abrami — Syphilides 
zoniformes de la face — Bull. 
Soc. franc, de dermat. et svph., 
Paris. 1908. xix. 312. 

Gaucher — Syphilis contractee pend- 
ant la gros-<esse — Ann. de 
therap. dermat. et svph.. Paris. 
1909, ix, 1-6. 

Gaucher — Chancre de la levre — .T. de 
med. de Paris, 1909. 2 s. xxi, 
323. 

Gaucher — Chancre de la gorge 
plaques muqueuses — J. de med. 
de Paris. 1909. 2 s. xxi, 433. 

Gaucher — Syphilis contractee pend- 
ant la grossesse nephrite syphili- 
tique et rapport azoturique. 
syphilide zosteriforme. chancre 
mou du doight — J. de med. et 
chir. prat., Paris, 1909, lxxx, 
731-734. 



Recent Bibliography. 



331 



Gaucher, Wickham et Degrais — De- 
formation de la levre chez une 
enfant par suite d'une bride 
flbro-sclereuse retractile post- 
syphilitique — Clinique, Paris, 
190!), iv, 660. 

Gaujoux, E. — Heredo-syphilis a 
manifestations viscerales multi- 
ples en particulier avec lesion 
des surrenales et hypertrophic 
du pylore chez un nourrisson- 
ne d'une mere saine en appear- 
ance et allaite par elle — Ann. 
de med. et chir. inf., Paris, 
1909, xiii, 731-738. 

Gaujoux, Madon et Brunei — Onyxis 
heredo-syphilitique — Montpel. 
med., 1909, xxviii, 476. 

Gauthier, P. — Iodurides a forme 
acneique et ecthymateuse chez 
une syphilitique ancienne — Lyon 
med., 1907, cix, 453-456. 

Gay, F. P. — The etiology and ex- 
perimental study of syphilis — 
Internat. Clin., Phila., 1907, 17 
s. iii, 199-210, 1 pi. 

Gay, F. P. and Fitzgerald, J. G. — 
The serum diagnosis of syphilis 
—Boston M. and S. J., 1909, 
clx, 157-161. 

Gay, F. P. — The serum diagnosis of 
syphilis — Boston M. and S. J., 
1909, clxi, 432-435. 

Gay, F. P. — The serum diagnosis of 
syphilis — Med. Communicat., 
Mass. M. Soc, Bost., 1909, xxi, 
589-599. 

Gayet — Deux cas de syphilis osse- 
use — Lyon med., 1909, cxiii, 
705-707. 

Gayet — Dystrophic osseuse d'origine 
heredo-syphilitique — Lyon med., 

1908, cxi, 432-434. 

Geber, H. — Ueber die entstehung 
und die histologic der sub-kut- 
anasn syphilitischen Gummen — 
Arch. f. Dermat. u. Syph., 
Wien. u. Leipz., 1908, xciii, 
335-350, 3 pi. 

Gebaroki, S. — Icterus syphiliticus 
prsecox — Gaz. lek., Warszawa, 

1909, 2 s., xxix, 747-750. 
Gefter, A. A. — Histology of fresh 

chancre — Russk. j kozhn ven 
boliezn, Kharkov, 1905, ix, 238. 
Gelle, E. et Leclercq, J. — Le pan- 
creas dans la syphilis heredi- 
taire — Echo med. du nord, 
Lille, 1908, xii, 525-533, 1 pi. 



Geraghty, J. T. — The practical value 
of demonstrating spirochseta 
pallida as an aid in the early 
diagnosis of syphilis—Mary- 
land M. J., Bait., 1908, li, 159. 

Geraghty, J. T. — The practical value 
of the demonstration of spiro- 
chseta in the early diagnosis of 
syphilis — Johns Hopkins Hosp. 
Bull., Bait., 1908, xix, 364-367. 

Geraghty, J. T. — The practical value 
of the demonstration of spiro- 
cheeta pallida in the early diag- 
nosis of syphilis — Am. J. Der- 
mat. and Gtenito-Urin. Dis., St. 
Louis, 1909, xiii, 47-50. 

Geraldini, A. — Delle sifilidi ignorate 
a decorso grave e anomalo — 
Policlin., Roma, 1906, xiii, sez 
prat., 842-846. 

Geraudel, E. et Menard, P. — 
Chancre simple de la levre uni- 
polaire ( constatation du bacille 
de Ducrey) inoculation positive 
— Bull, et mem. soc. d. med. 
d. Hop. de Paris, 1909, 3 s. 
xxviii, 430. 

Gershun, T. M. — Non-sexual syph- 
ilitic infection; rare case of 
primary indurated ulcer of the 
tongue — Vrach Gaz., St. 
Petersb., 1908, xv, 720. 

Getchell, A. C. — Syphilis as por- 
trayed by Shakespeare — Indiana 
M. J., 'indianap., 1908, xxvi, 
497. 

Giedgowd, W. — Extra-genital syph- 
ilis — Kron. lek., Warszawa, 
1906, xxvii, 1; 33, 68, 102, 131 
162. 

Giesma, G. — Bemerkung zur farbung 
der spiroehaeta pallida ( Schau 
dinn) — Deutsche med. Woch. 
Leipz. u. Berl., 1905, xxxi, 1026 

Giemsa, G. — Beitrag zur farbung 
der spirochaste pallida (Schaud 
inn) in ausstrichpraparaten — 
Deutsche med. Woch., Leipz. u, 
Berl., 1907, xxxiii, 676. 

Gierke, E. — Zur kritik der silber- 
spirochaeet — Berl. klin. Woch. 
1900, xliv, 75. 

Gierke, E. — Die intracellular lager 
ung der syphilisspirochseten — 
Centralbl. f. Bakteriol., 1 Abt. 
Jena, 1907, xliv, Orig. 348-358 

Gierke, E. — Das verhaltnis zwischen 
spirochavten und den orgauen 
kongenital syphilitischer kinder 
— Miinchen. med. Wchnschr., 
1906, liii, 393-396. 



332 



Recent Bibliography. 



Gifford, H. — -Some little-known pe- 
culiarities of the teeth in hered- 
itary svphilis — West. M. Rv., 
Lincoln* Neb., 1006, xi, 278-283. 

Gilbert, R. B. — Inherited syphilis — 
Internat. Clin., Phila.,'l908, 18 
s. 266-268. 

Gile, B. C. — Syphilitic enlargement 
of the salivary gland* — Am. 
Med., 1907, ns. "ii, 686-689. 

Gimlette, T. D— The pura of the 
Malay peninsula — J. Trop. M., 
Lond'., 1906, ix, 149-153. 

Ginzburg. I. I. — Hard chancre of the 
eyelid — Vestnik oftalmol, Mosk., 
1906, xxiii, 319-331. 

Girou, E. — Syphilis osseuse heredi- 
taire — Rev. sen. de clin. et de 
therap., Paris, 1909, xxiii, 788- 
791. 

Giuchard. A. — Chancre du nez syne- 
chie de la cloison et du cornet 
inferieur et obstruction du 
canal nasal consecutives— Rev. 
hebd. de laryngol., Paris, 1907, 
ii. 375-378. 

Glaser. J. A. — Kritische bemerkun- 
gen zu dem vortrag des Herrn W. 
Brosius: Eine syphilisendemie 
vor 12 jahren und ihre heute 
nachweisbaren folgen — Deutsche 
med. Presse, Berk, 1905, ix, 35. 

Glass, J. — Ueber spirochete pallida 
(treponema Schaudinn ) — 
Ztsehr. f. iirztl. Fortbild, Jena, 
1906, iii. 522-529. 

dinger, A. — Fall von syphilis pre- 
cox — Militararzt — Wien, 1907, 
xli, 29. 

Glover, J. — Surdite centrale bilat- 
erale heredo-syphilis a la sec- 
onde generation — Arch, inter- 
nat. de laryngol., Paris, xxv, 
88-90. 

Gluck, E. — Ein schwerer fall von 
syphilis — Pest. med. chir. 
Presse. Budapest, 1906, xlii, 
624. 

Goldhorn, L. B. — A rapid and cer- 
tain method of staining spiro- 
chete pallida — Proc. N. York 
Path. Soc, 1905-6. ns., v, 169- 
173, 2 pi. 

Goldhorn, L. B. — Concerning the 
morphology and reproduction of 
spirochaeta pallida and rapid 
method for staining the organ- 
ism-^!. Exp. M., N. Y., 1906, 
viii, 451-460, 2 pi. 



Goldreich, A. — Osteopathic bei he- 
reditarer lues — Mitt. d. Ge- 
sellsch. f. Inn. med. u. Kinderh. 
in Wien, 1907, vi, 165-169. 

Goldstein, O. — Welche bedeutung 
hat die serumdianostik der 
syphilis in gegenwartigen sta- 
dium fur den praktiker? — 
Prag. med. Woch., 1908, xxxiii, 
461-463. 

Gonder, R. — Beobachtungen ueber 
die endemische lues in Bosnien 
— Arb. a. d. k. Gsndhtsamte., 
Ber!., 190S, xxxiii, 139-144. 

Gongerot, H. — Diagnostic de la syph- 
ilis et des sporotrichoses sous- 
cutanees et eutanees — Ann. d. 
mal ven., Pari9, 1907, ii, 161- 
191. 

Gonka. A. — Relapse of late syphilis 
produced by a set of teeth — 
Przegl. lek., Krakow, 1908, 
xlvii, 569. 

Gonzalez, Castafaneda — Serodiag- 
nostico de la sifilis — Escuela 
de med. Mexico, 1909, xxiv, 485- 
491. 

Gordon, A. — Contribution to the 
study of syphilitic spirochsetas 
in cerebro-spinal fluid — Am. 
Med., Phila., 1905, x, 155. 

Gottheil, W. S. — Multiple muscular 
gummata, with bulbous onset — 
J. Cutan. Dis. incl. Syph., N. 
Y., 1906, xxiv, 136. 

Gottheil. W. S. — Syphiloderma 
framboesioides; two cases — J. 
Cutan. Dis. incl. Svph., N. Y., 
1907, xxv, 188. 

Gottheil. W. S.— Chancre of the 
penis in a bov of nine years — 
Post-Graduate, N. Y.,* 1908, 
xxiii, 200. 

Gottheil, W. S. — Syphilis maligna 
precox multiple subcutaneous 
gummata with general pustulo- 
rupial exanthem two months 
after infection — J. Cutan. Dis. 
incl. Syph., N. Y., 1908, xxvi, 
282. 

Gottheil. W. S. — Cicatricial con- 
tracture of unusual extent fol- 
lowing late syphlitic ulcerations 
of the skin — J. Cutan. Dis. incl. 
Syph.. N. Y., 1908, xxvi, 334. 

Gottheil, W. S. — Syphilis hereditaria 
tarda rupial and tubercular 
general exanthem — J. Cutan. 
Dis. incl. Svph., N. Y., 1908, 
xxvi, 332. 



Recent Bibliography. 



333 



Goudy — Chancre syphilitique de la 
levre superieure— J. de med. de 
Bordeaux, 1907, xxxvii, 216. 

Goudy — Ictere syphilitique secon- 
dare precoce — Arch, de med. 
nav., Paris, 1909, xcii, 383-388. 

DeGoyon — Attaque epileptiforme 
syphilitique — Ann. d'hyg. et de 
med. colon., Paris, 1909, xii, 
346-349. 

Gozony, L. — A lues serodiagnosti- 
kaja — Orvosi hetil., Budapest, 

1908, Hi, 591; 610. 

Graef, W.- — Akute gelbe leberatro- 
phie bei sekundarer lues — 
Deutsche med. Woch., Leipz. u. 
Berl., 1909, xxxv, 1925. 

Grafenberg — Der einfluss der syphi- 
lis auf die nachkommenschaft — ■ 
Arch. f. Gyneck., Berl., 1909, 
lxxxvii, 190-219. 

Grafenberg, E. — Ueber den zusam- 
menhang angeborener missbild- 
ungen mit der kongenitalen 
syphilis — Deutsche med. Woch., 
Leipz. u. Berl., 1908, xxxiv, 
1589-1591. 

Graham, J. C. — Notes on framboe- 
sia tropica (yaws) — Brit. M. 
J., Lond., 1905, ii, 1275. 

Graham, J. K. — The influence of 
syphilis upon health and lon- 
gevity — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1906, x, 71. 

Grandclement — Chancre syphilitique 
du grand angle de l'oil — Lyon 
med., 1905, ev, 224. 

Granjux — Le carnet individuel du 
syphilitique — Soc. franc. de 
prophyl. san. et mor. Bull., 
Paris, 1907, vii, 44. 

Grant, D. — Case of tertiary syphilis 
of superior maxilla simulating 
malignant disease — Polyclin., 
Lond., 1906, x, 160. 

Grant, D. — Case of malignant spe- 
cific ulceration in a young male 
patient — Proc. Boy. Soc. Med., 
Lond., 1908-9, ii; Laryngol. 
Sect. 77 

Grant, D. — Case of Hunterian sore 
inside the lip of a young woman 
— J. Laryngol., Lond., 1909, 
xxiv, 183. 

Grant, D. — Case of Hunterian sore 
inside the lip of a young woman 
— Proc. Roy. Soc. Med., Lond., 

1909, ii, Laryngol. Sect. 107. 



Gravagna — Due casi rari di clinica 
dermosifiiopatica sifilide pig- 
mentaria sifiloma primario del 
mignolo sinistro — Gazz. inter- 
naz. di med., Napoli, 1906, ix, 
987. 

Gravagna — Sulla transmissione della 
sifilide agli animali — Gazz. in- 
ternaz. di med., Napoli, 1908, 
xi, 317, 373. 

Gravagna — Due casi rari di clinica 
dermosifiiopatica sifilide pig- 
mentaria sifiloma primario dei 
mignolo sinistro — Gaz. internaz. 
di med., Napoli, 1907, x, No- 
saggio 5. 

De Grave, H. — Le sero-diagnostic de 
la syphilis — Presse med. beige, 
Brux., 1909, Ixi, 927-937. 

De Grave — Le sero-diagnostic de la 
syphilis — Presse med. beige, 
Brux., 1909, lxi, 329-340. 

Griffon, V. — Chancre syphilitique 
geant du dos de la main — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 323. 

Griffon, V. et Du Caste], J.— Spha- 
cele de la verge consectif a un 
chancre — Bull. Soc. franc, de 
dermat. et syph., Paris, 1905, 
xvi, 323. 

Griffon, V. et Abrami, P. — L'hydarth- 
rose de la syphilis secondaire; 
etude cytologique et experimen- 
tale de l'epanchement — Tribune 
med., Paris, 1906, ns. xxxviii, 
693. 

Grindon, J. — Recent additions to our 
knowledge of the chancre and 
of the primary stage of syphilis 
—St. Louis M. Rev., 1907, lv, 
348. 

Groll — Cinq observations de syphilis 
et neoplasmes — Dauphine-med., 
Grenoble, 1906, xxx, 145-153. 

Groll, L. — Chancre extra-genital lo- 
calisation a la muqueuse gen- 
ienne une rarete clinique — 
Dauphine med., Grenoble, 1908, 
xxxii, 127-133. 

Gros, H. — Phagedenisme tertiare 
terebrant de la face; destruc- 
tion du nez, de la voute pala- 
tine, atresie de l'orifiee des 
fosses nasales; destruction des 
levres et atresie de la bouche 
cryptophtalmie eicatricielle ac- 
quise et symblepharon — -Bull, 
med. de PAlgerie, Alger, 1909, 
xx, 461-464. 



334 



Recent Bibliography. 



Gross, L. — Urethral chancre, with 
misleading complications — Am. 
J. Dermatol, and Genito-Urin. 
Dis., St. Louis, 1905, ix, 227. 

Gross, L. — Lrethral chancre, with 
misleading complications — Pa- 
cific M. J., San Fran., 1905, 
xlviii, 347. 

Gross, S. u. Volk, R. — Serodiagnos- 
tische untersuehungen bei syph- 
ilis— Wien klin. Woch., 1908, 
xxi, 647- 650. 

Gross, S. u. Volk, R. — Weitere sero- 
diagnostisehe untersuehungen 
bei syphilis — Wien klin. Woch., 
1908, xxi, 1522-1524. 

Grosser — Wert und praktische be- 
deutung der sero-diagnostik bei 
lues— Med. Klin., Berl., 1909, v, 
1343-1350. 

Grossman — Sclerose initiale ayant 
apparu 50 jours apres le dernier 
coit — Rev. prat. d. mal cutan., 
Paris. 1906, v, 228. 

Grosman — Syphilis acquise conjugate 
chez un couple d'heredo-syph- 
ilitiques — ,T. d. mal. cutan. et 
syph., Paris, 1908, 499-501. 

Grosman — Un cas interessant de 
vitiligo psoriasis et syphilis — 
J. d. mal. cutan. et svph., Paris. 
L908, 501. 

Grouven. C. U. Fabry. H. — Spiroeha- 
ten bei syphilis — Deutsche med. 
Woch., Leipz. u. Berl., 1905, 
xxx i. 1469. 

Grouven, C. — Ueber positive syph- 
ilisimpfung am kaninchenauge 
—Mod. Klin., Berl., 1907, iii. 
774. 

Grouven. C. — Ueber bemerkenswerte 
resultate der syphilisimpfung 
beim kaninchen — Med. Klin.. 
Berl.. 1908. iv, 267-269. 

Grouven, C. — Ueber klinisch erkenn- 
bare allegemeinsyphilis beim 
kaninchen — Dermat. Ztschr., 
Berl., 1908, xv, 209-215. 

Grouven, C. — Ueber den nachweis 
der spirochete pallida bei kon- 
genitaler svphilis — Centralbl. f. 
Gvnak., Le'ipz., 1908, xxxii, 581- 
586. 

Grove, W. R.. Brown, J. and Hutch- 
inson. J. — The infectivity of in- 
herited svphilis — Brit. M. J., 
Lund.. 1906. i. 1501. 

Grove, W. R. — A family infected 
with svphilis — Brit. M. J., 
Lond.. 1906. i. 1400. 



Gramme — Ueber periostitis syph- 
ilitica cranii interna — Charite- 
Ann., Berl., 1906, xxx, 670-677. 

Grunbaum, A. S. and Smedley, R. D. 
— Xote on the transmissibility 
of svphilis to apes — Brit. M. J., 
Lond., 1906, i, 607. 

Grunfeld, R. L. — Zur diagnose der 
intra-urethralen initialsklerose 
—Wien med. Woch.. 1909, lix, 
4611-464. 

Gublin, G. F. — Erratic chancres — J. 
Row Army Med. Corps, Lond., 
1905, v, 525. 

Gueirrez, A. V. — Profilaxis de la 
sifllisj — Rev. med. d. Bogota, 
1905-6, 363. 

Guibaud, M. — Un cas de diagnostic 
d'heredo-syphilis dans le cabinet 
du stomatologiste — Rev. de 
stomatol., Paris, 1908, xv, 406- 
408. 

Guicciardi, G. — La spirocheta pal- 
lida nella placenta sifilitica — 
Ginecologia, Firenze, 1906, iii, 
260-272. 1 pi. 

Guicciardi, G. — Contribute alia ri- 
cerca degli anticorpi nel latte 
di donna sifilitica — Ginecologia, 
Firenze, 1908, v, 321-334. 

Guillain, G. et Hamel — Osteoarth- 
ropathies syphilitiques chez un 
malade presentant un signe 
d'ArgvlI-Robertson — Rev. neu- 
rol.. Paris, 1905. xiii, 774. 

Guillain, G. et Levv-Franckel — Mi- 
crodactylie symetrique aux 
mains et aux pieds chez une 
heredo-syphilitique — Bull, et 
mem. Soc. med. d. hop. de Paris, 
1907. 3 s.. xxiv, 839-895. 

Guilly — Aorte et syphilis, frequence 
de la coexistence chez les syph- 
ilitiques des aortites avec le 
tabes et la paralyses generates 
— Svphilis, Paris, 1905, iii, 
2588. 

Guinon et Beauvy — Abces des pou- 
mons chez un nouveau-ne syph- 
ilitique atteint d'infection om- 
bilicale — Ann. de med. et chir. 
inf., Paris, 1909, xiii, 197. 

fiuizzetti. P. — Untersuehungen ueber 
die veranderungen der epithe- 
lien der samenkanalichen und 
der spermatozoen in vier fallen 
von syphilis — Arch. f. Dermat. 
u. Svph., Wien u. Leipz., 1905, 
Ixxv] 227-256, 1 pi. 






Recent Bibliography. 



335 



Guszman, J. — Beitrage zur aetiologie 
der syphilisrezidive ■ — Wien. 
med. Woeh., 1909, lis, 1838; 
1903. 

Guszman, J. — Schaudinn-fele spiro- 
chaete pallida — Orvosi hetil, 
Budapest, 1905, xlix, 544. 

Guthrie, L. — Inherited syphilis — 
Rep. Soc. Study Dis. Child., 
Lond., 1908, viii, 107-111. 

Gutmann, A. — Mikuliczsche krank- 
heit in ihrer beziehung zur lues 
— Berl. klin. Wchnsehr., 1907, 
iii, 1141-1143. 



Hackett, W. A. and Aronstam, N. E. 

— A symposium on syphilis — 

Med. Age, Detroit, 1905, xxiii, 

121, 161. 
D'Haenens, E. — Syphilides papu- 

leuses suinantes dans l'urethre 

masculin — Bull. Soc. de med., 

d'Anvers, 1907, lxix, 92-95. 
Haenisch, G. F. — Beitrag zur Ront- 

gendiagnostik der knochensyph- 

ilis — Fortschr. a. d. Geb. d. 

Rontgenstrahlen, Hamb., 1907, 

xi, 449-453. 
Haenisch — Zur differential diagnose 

zwischen tumor und genitaler 

lues — Verhandl. d. deutseh. 

Rontg. Gesellsch., Hamb., 1907, 

iii, 154-156. 
Haggard, W. D. — Luetic ulcer of the 

ankle — South. Pract., Nashville, 

1909, xxxi, 162-164. 
Hahn, G. — Ueber moderne syphilis- 

forschung — Deutsche Monatsch. 

f. Zahnh., Berl., 1909, xxvii, 

260-269. 
Hahn, R. — Knochensyphilis in Ront- 

genbild — Deutsche med. Woeh., 

Leipz. u. Berl., 1906, xxxii, 

1397. 
Halberstadt et Nouet — Infantilisme 

thyroiden chez une heredo-syph- 

ilitique — Progres med., Paris, 

3s. xxiv, 541. 
Halberstaedter, L. — Weitere unter- 

suchungen ueber framboesia 

tropica — Ark. a. d. k. Gesund- 

heitsamte, Berl., 1907, xxvi, 48. 
Halkin, H. — L'etat actuel des con- 

naissances experimentales sur 

la syphilis — Scalpel, Liege, 

1908-9', lxi, 333-336. 



Hall, A. J. — Syphilis hereditaria 
tarda — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1907, xi, 212. 

Hallopeau et Deroye — Sur un cas 
de syphilide presentant un de- 
veloppement anormal au vois- 
inage de l'accident primitif — J. 
d. mal. cutan. et syph., Paris, 
1905, tome xvii, 426. 

Hallopeau, H. — Proliferations lo- 
cales in situ et a distance de 
1'agent infectieux de la syphilis 
pendant toute la duree de son 
evolntion — J. de mal. cutan. et 
syph., Paris, 1905, xvii, 641- 
653. 

Hallopeau, Laffitte et Krantz — Sur- 
un eas de syphilis hereditaire 
avee destruction partielle et 
malformation consecutive des 
maxillaires de la voute palatine 
et du pharynx — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1905, xvi, 16. 

Hallopeau, Laffitte et Krantz — Cas 
de diagnostic de cicatrices syph- 
ilitiques probables — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1905, xvi, 43. 

Hallopeau et Teisseire — Sur un cas 
de syphilis hereditaire — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 118. 

Hallopeau, H. — Note sur les photo- 
graphies des figures peruviennes 
antiques — Bull. Soc. franc, de 
dermat. et syph., Paris, 1905, 
xvi, 151. 

Hallopeau et Teisseire — Sur une de- 
formation en entonnoir de la 
paroi thoracique anterieure— 
Bull. Soc. de dermat. et syph., 
Paris, 1905, xvi, 154. 

Hallopeau et Debove — Sur un cas 
de syphilide presentant un de- 
veloppement anormal au vois- 
inage de l'accident primitif — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1905, xvi, 155. 

Hallopeau, H. — Nouvelle note sur 
les syphilides secondaires sub- 
ordonnees a l'action de voisinage 
du chancre indure — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1905, xvi, 169. 

Hallopeau, H. — Sur une recidive de 
syphilis au bout de 30 ans — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1905, xvi, 212. 



336 



Recent Bibliography. 



Hallopeau, H. — A propos d'une let- 
tre de M. Baldomero Sommer 
sur un cas probable de boubas — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1905, xvi, 240. 
Hallopeau et Granchamp — Eecidive 
de chancre indure ou ulceration 
tardive avec induration chon- 
droide — Bull. Soc. franc, de 
dermat. et syph., Paris, 1908, 
xvii, 90. 
Hallopeau et Roy — Sur un cas de 
proliferations locales predomi- 
nantes chez un malade atteint 
de syphilides seeondaires gen- 
eralises — Bull. Soc. franc, de 
dermat. et svph., Paris, 1906, 
xvii, 187-189." 
Hallopeau, H. et Donze — Sur un 
diagnostique tardif de syphilis; 
facilite par un nouveau procede 
d'investigation — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1906, xvii, 281-283. * 
Hallopeau, H. — Sur la pathogenie 
du doublement d'une orchite 
syphilitique — Bull. Soc. franc. 
de dermat. et syph., Paris, 1906, 
xvii. 289. 
Hallopeau, H. et Mace de Lepinay — 
Sur un cas de syphilis frater- 
nelle avec proliferation second- 
are au pourtour des accidents 
primitifs — Bull. Soc. franc, de 
dermat. et svph., Paris, 1906, 
xvii, 375. 
Hallopeau, H. et Mace de Lepinay — 
Localisations psoriasiques sur 
des syphilides — Bull. Soc. franc, 
de dermat. et syph., Paris, 1906, 
xvii, 438. 
Hallopeau, H. — Arguments en fa- 
veur de revolution du trep- 
onema pallidum dans l'organ- 
isme de l'homme et des grands 
singes — Ann. d. mel. ven., Paris, 
1906, i, 169-176. 
Hallopeau, H. et Dainville, F. — Sur 
un cas de syphilide tertiaire ser- 
pigineuse de la totalite du vis- 
age avec essai de son interpre- 
tation pathogenique. — Bull. soc. 
franc, de dermat. et syph., 
Paris, 1909, xx, 285-287. 
Hallopeau. H. et Boudet — Nouveau 
cas de proliferations locales in- 
tensives au voisinage d'un 
chancre indure — Bull. Soc. 
franc, de dermat. et syph., 
Paris. 1907, xviii, 5. 



Hallopeau, H. et Boudet — Sur une 
pandermatite penienne consecu- 
tive a des chancres indures — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1906, xvii, 499. 

Hallopeau. H. et Boudet — Sur un 
cas de syphilis tertiaire precoce 
avec gomme du frontal et per- 
foration — Bull. Soc. franc, de 
dermat. et syph., Paris, 1907, 
xviii, 8. 

Hallopeau, H. et Lasnier — Sur une 
desquamation en masse des reg- 
iones plantaires dans un cas de 
syphilis secondaire — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 54. 

Hallopeau, H. — Sur une epidemie de 
chancres simples — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1907, xviii, 89. 

Hallopeau, H. et Railliet — Sur un 
chancre de la paupiere infer- 
ieure — Bull. Soc. franc, de der- 
mat. et svph.. Paris, 1907, xviii, 
394. 

Hallopeau, H. et Gaston — Sur les 
localisations systematisees du 
treponema pallidum — Ann. d. 
mal. ven., Paris. 1907, ii, 641- 
655. 

Hallopeau, H. — A propos du phage- 
denisme du chancre simple — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1908, xix. 167-169. 

Hallopeau, H. — Herpes intra-buccal 
recidivant chez un malade at- 
teint anterieurement de syph- 
ilomes du voile du palais — Bull. 
Soc. franc, de dermat. et svph., 
Paris. 1908. xix, 205. 

Hallopeau, H. — Sur un cas de syph- 
ilides plantaires unilaterales et 
les enseignements qui en decou- 
lent — Bull. Soc. franc, de der- 
mat. et svph., Paris, 1908, xix, 
218-220. 

Hallopeau, H. et Francois-Dainville 
— Sur un cas de syphilides pap- 
uleuses avec atrophie et hyper- 
pigmentation — Bull. Soc. franc, 
de dermat. et svph., Paris, 
1908, xix, 238-240.' 

Hallopeau, H. et Dainville, F. — 
Chancre probable de la caron- 
cule consectif a un chancre de 
la verge eruption syphilitique 
secondaire — Bull. Soc. franc, de 
dermat. et svph.. Paris, 1909, 
xx, 73. 



Recent Bibliography. 



337 



Hallopeau, H. et Francois-Dainville 
— Sur un cas d'hyperplasie 
syphilis douloureuse des deux 
mamelles chez une bonne — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1909, xx, 39-41. 

Hallopeau, H. — Syphilide ulcereuse 
de la marine et de la levre su- 
perieure; lupus pernio et aene 
rosacee — Bull. Soc. franc, de 
dermat. et syph., Paris, 1909, 
xx, 74-76. 

Hallopeau, H. et Gastou — Sur les 
localisations systematisees du 
treponema pallidum — Internat. 
Dermat. Cong., vi, 1907 Tr., N. 
Y., 1908, ii, 728-739. 

Hallopeau, H. — Sur le progres re- 
cente dans Petude elinique de 
1'evolution de la syphilis — Ann. 
d. mal. ven., Paris, 1909, iv, 
687-698. 

Haltenhoff — Heredo-syphilis a la 
troisieme generation — Eev. med. 
de la Suisse Rom., Geneve, 1906, 
xxvi, 349-352. 

Hamill, E. H. — Syphilis from a life 
insurance standpoint — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1909, xiii, 144-148. 

Hammaeher, J. P. M. — Over de 
spirochete pallida — Med. 
Weekbl., Amst., 1905-6, xii, 305. 

Hamonic, P. — Perionyxis syphilit- 
ique — Eev. clin. d'androl. et de 
gynec, Paris, 1906, xii, 327. 

Hamonic, P. — De la leucoplasie buc- 
cale dans ses rapports avec la 
syphilis — Eev. clin. d'androl. et 
de gynec, Paris, 1906, xii, 359- 
574. 

Hand, A., Jr. — Some symptoms in 
childhood suggestive of congeni- 
tal syphilis — Proc. Phila. Co. 
M. Soc, Phila., 1905-6, xxvi, 
424-426. 

Hand, A., Jr. — Some symptoms in 
childhood suggestive of congeni- 
tal syphilis — Am. J. Dermat. 
and Genito-Urin. Dis., St. 
Louis, 1906, x, 416-420. 

Hansteen, E. H. — Spirochete pal- 
lida (Res 788)— Norsk Mag. f. 
Laegevidensk, Kristiania, 1906, 
s. E iv, 781-788, 1 pi. 

Harris, F. G. — The parasitology of 
syphilis — J. Am. M. Ass., Chic- 
ago, 1909, liii, 757-762. 



Harris, F. G. and Corbus, B. C.— 
The clinical value of the spiro- 
chaeta pallida in the diagnosis 
and treatment of syphilis — J. 
Am. M. Ass., Chicago, 1903, li, 
1928-1933. 

Hartigan, W. — A case of tertiary 
syphilis obscured by typhoid 
sequela? — J. Tropical M., Lond., 
1906, viii, 318. 

Hartmanni — Beitrage zur lebens- 
dauer der spirochseta pallida — 
Dermat. Ztschr., Berl., 1909, 
xvi, 663-640. 

Harttung, W. — Luetische gelenk- 
krankungen — Med. Klin., Berl., 
1909, v. 991-995. 

Hartzell — Tubercular syphiloder- 
mata resembling tinea sycosis — ■ 
J. Cutan. Dis., inel. Syph., N. 
Y., 1908, xxvi, 327. 

Harvey, D. — A note on the staining 
of spirochete pallida — Jour. 
Eoy. Army Med. Corps, Lond., 
1905, v, 409. 

Harvey, D. and Bousfield, L. — Note 
on the spirochete found in 
syphilis — J. Eoy. Army Med. 
Corps, Lond., 1905, v, 263. 

Hastings, S. — Some clinical notes 
on gummatous affections of 
lymphatic glands — Middlesex 
Hosp. J., Lond., 1908, xii, 59-63. 

Hastings, T. W. — Observations on 
spirochete in syphilis — Proc. 
N. York Path. Soc, 1905-6, ns., 
v, 114-120. 

Haubold — Rontgenaufnahmen von 
knochensyphilis — Deutsche med. 
Woeh., Leipz. u. Berl., 1908, 
xxxiv, 1749. 

Hauck, L. — Ueber das verhalten der 
leukocyten im 2 stadium der 
syphilis vor und nach einleit- 
ung der queekssilbertherapie — 
Arch. f. dermat. u. syph., Wien 
u. Leipz., 1906, lxxviii, 45-68. 

Hauck, L. — Ueber das verhalten der 
leukocytem im 2 stadium der 
syphilis vor und nach einleit- 
ung der quecksilbertherapie — 
Arch. f. Dermat. u. Syph., 
Wien u. Leipz., 1906, lxxviii, 
289-318. 

Hauck, L. — Zur frage des klinischen 
wertes der Wassermann-Neis- 
ser-Bruckschen syphilis-reak- 
tion — Miinchen med. Woch., 
1909, lv, 1265-1268. 



338 



Recent Bibliography. 



Haughton, H. S. — Report on spiro- 
chseta pallida found in an early 
ease of extra-genital lues — Proc 
N. York Path. Soc., 1905-6. ns. 
v, 165-167. 

Haushalter — Osteopathic heredo- 
syphilitique chez un enfant de 
5 ans — Rev. med. de l'ouest 
Nancy, 1906, xxxviii, 414. 

Haushalter et Hoche — Un cas 
d'heredo-syphilis congenitale 
avee lesions considerables du 
foie et des capsules surrenales 
— Rev. med. de l'ouest, Nancy, 
1909. xli, 152-155. 

Hausland. P. — Spirochsete pallida 
Schaudinn — Xord Tidsskr. f. 
Terapi, Kobenh., 1904-5. iii. 
383. 

Havelburg, W. — Estudo succinto da 
syphilographia moderna — Rev. 
med-chir, de Brazil, Rio de 
Jan . 1908, wi. 283-299. 

Hawkins, ,T. A. — Some things not 
generally known alxmt syphilis 
—X. York M. J., 1907, ixxxvi, 
L069-1072. 

Hayward. E. H.— The spirochsete 
pallida — T. Mich. M. Soc, De- 
troit, 1906, v, 154-158. 

Heath, A. D. — Congenital syphilis, 
circinate eruption — Rep. Soc. 
Study Dis. Child., Lond., 1908, 
viii, 392. 

Hebert. A. — Chancre syphilitique du 
fiontz — Xormandie med., 
Rouen, 190". x xii, 329. 

Hecht. H. — Die bisherigen ergebnisse 
der Wassermannschen syphilis- 
reaktion — Prag med. Wchnsehr., 
190S. xxxiii. 737. 

Hecht, H. — Untersuchungen ueber 
den zusammenhang zwischen 
spitzem kondylom und spiro 
chseten — Arch. f. dermat u. 
syph., Wien u. Leipz.. 1908, xc, 
67-76. 

Hecht, H. — Ein vereinfachung der 
komplementbindungsreaktionbei 
syphilis — Wien klin. Woch., 
1909, xxii, 338-340. 

Hecht — Lichen lueticus mit nega- 
tiver Was9ermannscher reak- 
tion — Deutsche med. Woch.. 
Leipz. u. Berl.. 1909. xxxv, 1677. 

Hecht. V. et Wilenko, M— Ueber 
die untersuchung der spiro- 
chsete pallida mit dem tresch- 
verfahren — Wien. klin. Woch., 
1909, xxii, 932. 



Hedren, G.- — Untersuchungen ueber 
spirochsete pallida bei kongeni- 
taler syphilis — Centralbl. f. 
Bakteriol., 1 Abt., Jena, 1908, 
xlvi, Orig. 232-247. 

Heermann — Ueber luetische infek- 
tionen bei aertzen — Milnchen 
med. Woch., 1908, lv, 2448. 

Heggie, W. C. — Syphilis — Canada 
Lancet, Toronto, 1908-9, xlii, 
349-352. 

Heidingsfeld, M. L. — Dual genital 
and extra-genital chancres at a 
distance — Med. Rec, N. Y.„ 
1905, vol. lxviii, f. 261. 

Heidingsfeld. M. L. — Syphilitic ex- 
tra-genital chancre on the tip 
of the nose — Lancet-Clinic, Cin- 
cin., 1905. ns. lv, 523. 

Heidingsfeld, M. L. and Markley, A. 
J. — Spirochaeta pallida, a pre- 
liminary report on the new mi- 
crobe of syphilis — Lancet- 
Clinic, Cincin., 1905, ns. lv, 
608-611. 

Heidingsfeld, M. L. — Case of ter- 
tiary syphilis resembling lupus 
— Lancet-Clinic, Cincin., 1908, 
xciv. 191. 

Heidingsfeld, M. L.— The Wasser- 
mann diagnostic test for syph- 
ilis — Lancet-Clinic, Cincin., 
1909. ci, 389-394. 

Heidingsfeld. M. L. — The diagnosis 
of syphilis — Ohio M. J., Colum- 
bus, 1909, v, 379-385. 

Heinrich — Ueber lues hereditaria 
tarda — Arch. f. dermat. u. 
svph.. Wien u. Leipz... 1908, 
xc, 151-178, 3 pi. 

Heller. J. — Die haufigkeit der here- 
ditaren syphilis in Berlin— Berl. 
Klin. Woch., 1909, xlvi, 1315. 

Heller. J. u. Rabinowitsch, Lydia — 
Eink'p mitteilungen ueber die 
praktisch-diagnostische v e r - 
wertbarkeit der untersuchung 
auf spirochsete pallida — Med. 
Klin.. Berl.. 1906. ii, 735-737. 

Heller, J. — Ueber saugling9heime 
fur hereditar syphilitisclie kin- 
der — Ztschr. f. Bekampf. d. 
Geschlechtskr., Leipz., 1907, vi, 
50. 

Heller, J. — Ueber die organisation 
von heimen fur hereditar syphi- 
litisclie — Kinder. Dermat. 
Ztschr., Berl., 1907, xiv, 497- 
500. 



Recent Bibliography. 



339 



Heller, J. — Sind besondere heime 
fur syphilitische kinder not- 
wendig oder wiinschenswert ? — 
Med. reform., Berl., 1908, xiv, 
160. 

Heller, J. — Zur kasuistik seltener 
nagelerkrankungen ; 7 striae 
longitutudinales medians ungui- 
num syphilitica — Dermat. 
Ztschr., Berl., 1909, xvi, 31-34. 

Helot — Gomme para-maatoidienne — 
Areh. internat. de laryngol., 
Paris, 1906, xxii, 125-127. 

Hennebert, C. — Reactions vestibu- 
laires dans les labyrinthites 
heredo-syphilitiques — Presse 
oto-laryngol. beige, Brux., 1909, 
Tin, 19*6- 201. 

Herandez, T. — Heredo-sifilis — Cron- 
med-quir. de la Habana, 1907, 
xxxiii, 381-385. 

Herandez, T. — Llanto sifllitieo — 
Cron. med. de la Habana, 1908, 
xxxiv, 126-130. 

L.Hermitte, J. et Rouquette, P. — 
Documents relatifs a la syph- 
ilis; exemples de contagion ex- 
tragenitales a la nourricerie de 
l'Hotel-Dieu du Mans (1591- 
1596) — France med., Paris, 
1907, liv, 57. 

Herrington, L. P. — Vaccine virus 
and syphilis — -Georgia Pract., 
Savannah, 1906, ii, 324. 

Herrman, C. — A case of congenital 
syphilis — Arch. Pediat., N. Y., 
1907, xxiv, 467. 

Herrman, C. — A note on the spiro- 
cheta pallida — N. York M. J., 
1905, lxxxii, 1205. 

Herzheimer — Ueber lues maligna 
und spirochete pallida — Ver- 
handl. d. deutsch dermat. Ges- 
sellsch., Berl., 1907, 280-291. 

Herxheimer, G. — Zur aetiologie und 
pathologischen anatomie der 
syphilis — Ergebn. d. allg. Path. 
u. path. Anat., Wiesb., 1907, 
xi, 1-309. 

Herxheimer, K. u. Hubner, H. — 
Ueber darstellungweise und be- 
fund der bei lues vorkommenden 
spirochete pallida — Deutsche 
med. Woch., Leipz. u. Berl., 

1905, xxxi, 1023. 
Herxheimer, K. — Weitere mitteilun- 

gen ueber die spirochete pal- 
lida (treponema Schaudinn) — 
Miinchen. Med. Wchnschr., 

1906, liii, 310-312. 



Herxheimer, G. — Ueber dis patholo- 
gische anatomie kongenitalen 
lues — Med. Klin., Berl., 1907, 
iii, 1561-1564. 
Herxheimer, K. — Ueber die bezie- 
hungen der spirochete pallida 
zur syphilis — Med. Klin., Ber- 
lin, 1905, Bd. i, s. 797. 

Herxheimer, K. — Zur kenntnis der 
spirochaete pallida — Munch, 
med. Woch., 1905, lii, s. 1861. 

Herxheimer, K. u. Loser— Ueber 
den bau der spirochete pallida 
— Miinch. med. Woch., 1905, lii, 
2212. 

Herxheimer, G. — Zur pathologischen 
anatomie der kongenitalen syph- 
ilis — Ergebn. d. allg. Path. u. 
Anat., Wiesb., 1908, xii, 499- 
575. 

Herzfeld, A. — Seltene localisation 
eines luetischen primaraffectes 
— Dermat. 'Centralbl., Leipz., 
1906, ix, 134. 

Heuck — Fall von kongenitaler syph- 
ilis — Berlin klin. Woch., 1906, 
xliii, 519. 

Hewlett, R. T. — Spirochete or spi- 
rocheta a question of nomen- 
clature^ — Brit. M. J., Lond., 
1905, ii, 1616. 

Hiller, K. — Serum diagnosis of 
syphilis (Wassermann reac- 
tion) — Intercolon. M. J., Aus- 
tralas, Melbourne, 1908, xiii, 
582-595. 

Hinrichs, W. — Der serologisehes 
luesnachweiss mit der Bauer- 
schen modifikation der Wasser- 
mannschen reaktion — Med. 
Klin., Berl., 1908, iv, 1349-1353. 

Hirschberg, J. — Zwei alte falle von 
lues mit augen-symptomen — 
Centralbl. f. prakt. Augenh., 
Leipz., 1909, xxxiii, 295-297. 

Hirschberg, L. K. — The method ol 
Giemsa for staining the spiro- 
cheta pallida — J. Am. M. Ass., 
Chicago, 1905, xlv, 1086. 

Hirtz — A propos du treponema pal- 
lidum de Schaudinn — Bull, et 
mem. Soc. med. d. Hop. de 
Paris, 1906, 3 s., xxiii, 330-332. 

Hochsinger K. — Zwanzigjahrige 
dauerbeobachtung eines falles 
von angeborener syphilis (par- 
oxysmale hamuglobinurie aorti- 
tis infantilismus tabes) — Wien 
med. Presse, 1905, xlvi, 1281- 
1291. 



340 



Recent Bibliography. 



Hochsinger, K. — Angeborene knoch- 
enlues mti kontrakturen und 
spontan geheilter epiphyseolysis 
— Mitt. d. Gesellsch. f. inn. 
med. u. kinderh. in Wien, 1909, 
vii, 161. 

Hochsinger — Fall von glossitis dif- 
fusa heredo-syphilitica — Mitt. 
d. Gesellsch. f. inn. Med. u. 
Kinderh. in Wien, 1005. iv, 200. 

Hochsinger — Fall von glossitis dif- 
fusa heredo-syphilis — Mitt. d. 
Gesellsch. f. inn. med. u. Kin- 
derh. in Wien, 1905, iv, 260. 

Hochsinger. C. — Ein fall von poly- 
myositis heredo-syphilitica im 
sauglingsalter — Wien med. 
Woch.. 1905. Bd. Iv, s. 1369. 

Hochsinger, C. — Hydrozephalus und 
spina bifida (Mydozephalus) bei 
hereditarer lues — Centralbl. f. 
Kinderh., Leipz... 1907. xii, 189- 
191. 

Hochsinger. K. — Drei falle con her- 
editarsyphilitscher schadelhy- 
pertrophie — Mitt. d. Gesellsch. 
f. inn. Med. u. Kinderh. in 
Wien, 1905, iv, 43. 

Hochsinger, K. — Ueber die verhiit- 
ung der syphilis in der halte- 
kinderpflege — Monatsch. f. 
Gsndhtapfig., Wien, 1908, xxvi, 
184-187. 

Hodge, S. R. — Syphilis as seen in 
i hina — China M. J., Shanghai. 
1907. xxi. 237-244. 

Hoehne, F. — Was leistet zur zeit die 
Wassermannsche reaktion fiir 
die praxis? — Med. Klin., Berk. 
190S. iv. 1787-1790. 

Hoehne. F. — Die serumdiagnose der 
syphilis — Dermat. Ztschr.. Berl., 
190S. xv. 146-154. 

Hoehne. F. — Ueber die verwendung 
von urin zur Wassermannsehen 
svphilisreaktion — Berl. klin. 
Woch.. 1908, xlv. 1488. 

Hoehne. F. — Leber das verhalten des 
serums von scharlachkranken 
bei der Wassermann'schen re- 
aktion auf syphilis — Berl. klin. 
Woch.. 1908,* xlv. 1717-1719. 

Hoehne. F. — Ueber die bedeutung 
der positiven Wassermannsehen 
reaktion — Dermat. Ztschr.. 
Berl.. 1909, xvi. 273-281. 

Hoehne. F. — Die Wassermann'sche 
reaktion und ihre beeinfliissung 
durch die therapie — Berl. klin. 
Woch... 1909. xliv, 869-873. 



Hoffman, E. — Die aetiologie der 
syphilis — Dermat. Ztschr., Berl., 
1909, xvi, 687-704, 2 pi. 

Hoffman, E. — Parasitenbefunde bei 
menschlicher syphilis — Inter- 
nal Dermat. Con. Tr., N. Y., 
1908, ii, 677-691. 

Hoffmann, E. — Venenerkriinkungen 
im verlauf der sekundarperiode 
der syphilis — -Arch. f. Dermat. 
u. Syph.. Wien u. Leipz., 1905, 
lxxii'i, 39, 245, 8 pi. 

Hoffmann, E. — Venenerkrankungen 
im verlauf der sekundarperiode 
der syphilis — Arch. f. Dermat. 
u. Syph., Wien u. Leipz., 1905, 
lxxii'i. 245-300, 8 pi. 

Hoffmann, E. — Ueber die spirochete 
pallida — Deutsche med. Woch., 
Leipz. u. Berl., 1905, xxxi, 1710. 

IloH'mann. E. — Spirochsetenbefunde 
bei syphilis — Berl. tieriirzt. 
Woch., 1905, 389. 

Hoffmann, E. — Nachtrag zu der ar- 
beit von F. Schaudinn und E. 
Hoffmann ueber spirochete pal- 
lida bei syphilis, etc. — Berl. 
Klin. Woch.'. 1905, xlii, 726. 

Hoffmann, E. — Weitere mitteilungen 
ueber das vorkommen der spiro- 
chete pallida bei syphilis — 
Berl. klin. Woch., 1905. xlii, 
1022. 

Hoffmann, E. — Spirochete pallida 
bei einen mit blut geimpften 
makaken — Berl. klin. Woch. 

1905, xlii, 1450. 

Hoffmann, E. — Ueber eines fall von 
zum teil gangrosen chancres 
mixtes an lippe und zunge mit 
Bpfiter auftretenden pseudo- 
chancre am unterarm— Dermat. 
Ztschr., Berlin. 1905. Bd. xii, 
s. 491, 1 pi. 

Hoffmann. E. — Experimented un- 
tersuchungen ueber die infek- 
tiositat des syphilitischen blutes 
— Deutsche med. Wchnschr., 
Leipz. u. Berl., 1906, xxxii, 
496-499. 

Hoffmann. E. u. Beer, A. — Weitere 
mitteilungen ueber den nach- 
weis der spirochsete pallida im 
gewebe — Deutsche med. Woch.. 
Leipz. u. Berl., 1906. xxxii, 869- 
872. 

Hoffmann. E. Ueber die diagnos- 

tische bedeutung der spirochete 
pallida — Berl. klin. Woch., 

1906, xliii, 1421-1423. 



Recent Bibliography. 



341 



Hoffmann, E. u. Halle, A. — Ueber 
eine bessere darstellungsart der 
spirocheta pallida im ausstrich 
— Miinchen. med. Woch., 1906, 
liii, 1516. 

Hoffmann, E. — Mitteilungen und 
demonstrationen ueber experi- 
mentelle syphilis spirochete 
pallida und andere spirochaten- 
arten — Centralbl. f. Bakteriol., 

1 Abt., Jena, 1906, xxxviii, 108- 
113. 

Hoffmann, E. u. von Prowazek, S. — 
Untersuchungenen ueber die 
balanitis und mundsspirocheten 
Centralbl. f. Bakteriol., 1 
Abt., Jena, 1906, xli, 741, 1 pi. 

Hoffmann, E. — Mitteilungen und 
demonstrationen ueber experi- 
mentelle syphilis spirocheta 
pallida und andere spirocheten- 
arten — Dermat. Ztsehr., Berl., 
1906, xiii, 561-565. 

Hoffmann, E. — Die aetiologie der 
syphilis nach dem gegenwarti- 
igen stand unserer kenntnisse 
Verhandl. d. deutsch. dermat. 
Gesellsch., Berl., 1907, 115-223, 

2 pi. 

Hoffmann, E. — Demonstration von 
mit syphilis geimpften affen — 
Berl. klin. Woeh., 1907, xliv, 
254. 

Hoffmann, E. u. Bruning, W. — Ge- 
lungene uebertragung der syph- 
ilis auf hunde — Deutsche med. 
Woch., Leipz. u. Berl., 1907, 
xxxiii, 553. 

Hoffmann, E. u. Blumenthal, F. — 
Die sero-diagnostik der syph- 
ilis und ihre verwertbarkeit in 
der praxis — Dermat. 2/tschr., 
Berl., 1908, xv, 23-36. 

Hoffmann, E. u. Lohe, H. — Allge- 
meine disseminierte hautsyph- 
ilide bei niederen affen nach 
impfung in den hoden — Berl. 
klin. Woch., 1908, xlv, 1833- 
1835. 

Hoffmann, E., Lohe, H. u. Mulzer, 
P. — Syphilitischer initialaffekt 
der bauchhaut an der einstich- 
stelle nach impfung in die ho- 
den von affen und kaninchen — 
Deutsche med. Woch., Leipz. u. 
Berl., 1908, xxxiv, 1183. 

Holm, N. — The course of hereditary 
syphilis — Bibliot. f. Laeger, 
Kobenh., 1905, 8 R vi, 253-279. 



Horand — La cephalalgie prolongee 
comme signe de syphilis — Lyon 
med., 1909, cxii, 317-323. 

Horand, R. — Les spirochetes de 
Schaudinn et Hoffmann et les 
formes evolutives de l'hemo- 
protiste de la syphilis — Lyon 
med., 1905, civ, 1223, 1293. 

Horand, R. — Abondance extreme de 
treponemes pallida et de spiro- 
chetes dans l'onyxis syphilit- 
ique — Belgique med., Gand- 
Haarlem, 1906, xiii, 75. 

Horand, R. — Chancre syphilitique 
des levres transforms in situ en 
un syphilome diffus tertiaire; 
destruction ulcereuse d'une par- 
tie des levres sclerose labiale 
consecutive stenose cicatricielle 
progressive — Lyon med., 1908, 
ex, 1072-1078; incl. 1 pi. 

Horvath, K. — The direct contagion 
by the semen in tertiary syph- 
ilis — Bor-es bujakort, Budapest, 
1905, 7. 

House, W. — The phophylaxis of 
syphilis and its sequelae — 
Northwest Med., Seattle, 1905, 
iii, 241-247. 

House, W. — Some nervous manifes- 
tations of syphilis — Am. J. Der- 
mat. and Genito-Urin. Dis., St. 
Louis, 1908, xii, 408-410. 

Howe, W. C. — Hereditary syphilis 
of the anus and rectum — Am. 
J. Dermat. and Genito-Urin. 
Dis., St. Louis, 1906, x, 318. 

Hubner, H. — Ueber den jetzigen 
stand unserer kenntnisse von 
der spirochete pallida — Der- 
mat. Ztsehr., Berl., 1905, xii, 
718-730. 

Hubner, H. — Neuere arbeiten ueber 
die spirochete pallida — Dermat. 
Ztsehr., Berl., 1906, xiii, 617- 
636. 

Hudelo et Emery. — Syphilis intes- 
tinale — Ann. d. mal. ven., Paris, 
1909, iv, 657-686. 

Hudelo et Herrison — Gommes sous- 
cutanees multiples de nature 
indeterminee peut-etre tubercu- 
leuses — Bull. Soc. franc, de 
dermat. et syph., Paris, 1905, 
xvi, 120. 

Hudelo, L. — De la multiplicity des 
chancres syphilitiques — Medecin 
prat., Paris, 1906, 65. 



342 



Recent Bibliography. 



Huebschinann, P. — Spirochete pal- 
lida ( Schaudinn ) und organ- 
erkrankungen bei syphilis con- 
genita— Berl. klin. Woch., 1906, 
xliii, 796-798. 

Hugel. G. — Quelques resultats 
d'etudes experimentales sur la 
syphilis — Ann. d. mal. ven., 
Paris. 1908, iii. 737-741. 

Hunkin. S. J. and Harker, G. A.— 
Syphilis of bones and joints — 
Calif. State J. M., San Fran., 
1908, vi, 379-385. 

Hunt. V. V. — Syphilis; some 
thoughts on its pathology and 
treatment — Med. Standard, 
Chicago, 1906, xxix, 238. 

Hunter, C. H. — A gumma in the 
abdominal wall — Northwest 
Lancet, Minneap., 1905, xxv, 
132. 

Hutchinson, J. — Some facts as to 
the non-inheritance of syphilis 
under conditions apparently in- 
volving ususual risk — Polyclin., 
Lond., 1905, ix, 63. 

Hutchinson, J. — A clinical lecture 
on the transmission of syphilis 
to the third generation — Med. 
Press and Circ, Lond., 1906, 
ns. lxxxii, 110-113. 

Hutchinson. J. — Notes on an exhi- 
bition of illustrations of syph- 
ilis at the Clinical Museum — 
Med. Mag., Lond., 1908, xvii. 
569-573. 

Hutchinson, J. — A second infection 
five years after complete syph- 
ilis; three chancres of extreme 
duration — Polyclinic, Lond., 

1908, xii. 67. 

Hutchinson, J. — Experimental syph- 
ilologv — Brit. M. J., Lond.. 
1908, 'ii, 1215. 

Hutchinson, J. — Notes chiefly on 
svphilis — Polvelin., Lond. ,1909, 
xiii, 33-38. 

Hutchinson, J. — Jand-list of the por- 
traits illustrating syphilitic 
symptoms and conditions — 
Polvelin., Lond.. 190S, xii, 120; 

1909. xiii, 7, 18. 
Hutchinson, J. — On auto-inoculation 

and re-infection of syphilis — 
Lancet, Lond., 1909, 'i, 1509- 
1512. 
Hutchison, J. — On auto-inoculation 
and reinfection of syphilis — 
Proc. Roy. Soc. Med.. Lond., 
1908-9, ii,' Surg. Sect., 225-237. 



Hutchinson, J. — Syphilitic leuco- 
derma and the pigmentary 
syphilide — Brit. M. J., Lond. 
1909, i, 85-87. 

Hutinel — Manifestations de la syph 
ilis hereditaire chez le nouveau 
ne — J. de med. int., Paris, 1908 
xii, 301-303. 

Hutipel — Manifestations de la syphi 
lis hereditaire chez le nouveau 
ne — Gaz. d. mal. infant., Paris 
1908, x, 101-164. 

Hyde. J. N. — Cutaneous manifesta 
tions of svphilis — Illinois M. J. 
Springfield. 1909, xv, 383-388. 

Hyde, J. N. — Syphilis as related to 
the problems of longevity — 
Med. Exam, and Pract., N. Y. ( 
1905, xv, 273-280. 

Hyde, J. N. — Syphilis as related to 
the problems of longevity — 
Medicine, Detroit, 1905, xi, 259- 
268. 



Imhoff, F. — Influence mortelle d'une 
syphilis conceptionnelle latente 
sur les enfants nes ulterieure- 
ment d'un homme non syph- 
ilitique — Ann. d. mal. ven., 
Paris, 1909, iv, 49. 

Imhof-Bion, 0. — Ueber fieberer- 
scheinungen in den spatstadien 
der syphilis — Med. Klin., Berl., 
l!10fp,"v, 766-769. 

Impallomeni, G. — Intorno as una 
pretesa infezione sifilitica — 
Gazz. med. di Roma, 1905, 
xxxi, 579-592. 

Imparati, E. — La sifilide ereditaria 
della seconda generazione (er- 
edo-sifilide) — Gazz. d. osp. Mi- 
lano, 1907, xxviii, 273-282. 

Ingerbrans et Arquembourg — Foie 
ficele syphilitique rein a deux 
ureteres atherome de l'aorte — 
Echo med. du nord, Lille, 1907, 
xi„ 185. 

Irsay, A. — Subglottikus gumma gy- 
ogult esete ( cured ) — Orvosi 
hetil, Budapest, 1907, li, 37. 

Isaak, H. — Demonstration eines fall 
extragenitaler syphilis — Berl. 
klin. \Ynch., 1906," xliii, 1606. 

Isabolinski. M. — Clinical importance 
of Wassermann's reaction — 
Yrach Gaz., S. Peterb., 1909, 
xvi, 481; 536. 



Recent Bibliography. 



343 



Isabolinski, M. — Beitrage zur klini- 
sehen beurteilung der serum- 
diagnostik der syphilis — Arb. a. 
d. Inst. z. Erforsch. d. infek- 
tionskrankh. in Bern, Jena, 
1909, 3 s. Hit., 1-21. 

Isabolinski, M. — Weitere untersuch- 
ungen zur theorie und praxis 
der sero-diagnostik bei syphilis 
— Ztschr. f. Immunitiitsforsch., 
Jena, 1909, iii, 143-158. 

Ivanyi, E. — Extra-genitalis syphilis- 
infection, ketoldali emblosklero- 
sis. Syphilis — bilateral scle- 
rosis of the breast — Orvosi he- 
til., Budapest, 1906, 1, 243. 

Ivanyi, E. — One hundred and thir- 
ty-eight cases of extra-genital 
syphilis infection — Am. J. Der- 
mat. and Genito-Urin. Dis., St. 
Louis, 1907, xi, 269-271. 

Ivinhoff, V. V. — Schaudinn's spiro- 
cheta and its relationship to 
syphilis — Izviest. Imp. Voyenno- 
Med. Akad., St. Petersb., 1905, 
xi, 55. 



J— Die spirochete pallida als er- 
reger der syphilis — Report d. 
prakt. Med., Leipz., 1905, ii, 
352. 

Jackson, F. K. — Syphilis and pro- 
phylaxis — Vermont M. Month., 
Burlington, 1905, xi, 87-92. 

Jacobi, E. — Der einfluss der aufhe- 
bung der plizierarztlichen pros- 
titutiertenuntersuchung auf der 
ausbreitung der syphilis in 
Freiburg i B. — Mtinehen med. 
Woch., 1909, lvi, 1164. 

Jacque, L.— La spirochete de la 
syphilis — J. med. de Brux., 
1905, tome x, 406. 

Jacquet, L. et Parre — Syphilis a la 
troiseme generation ( heredo- 
syphilis virulente de seconde 
generation) — Bull, et mem. soc. 
med. d. hop. de Paris, 1909, 
3 s. xxviii, 197-199. 

Jacquet, L. et Sezary, A. — Des 
formes atypiques et degenera- 
tives du treponeme pale — Bull. 
et mem. Soc. med. d. Hop., 
Paris, 1907, 3 s. xxiv, 114. 

Jacquin — Restif de la Bretonne pre- 
curseur de Schaudinn — Chron. 
med., Paris, 1907, xiv, 162. 



Jadassohn — Die bedeutung der 
modernen syphilis forschungen 
besonders der serum-diagnostik 
fur die klinik der syphilis — 
Cor-Bl. f. schw. aerzte, Basel, 
1909, xxix, 145-155. 

Jadassohn, J. — Hereditaire lues bei 
zwei schwestern mit localisa- 
tion in nase und mundhohle 
und mit lymphadenitis gum- 
mosa — Verhandl. d. deutsch. 
dermat. G-esselsch., 1906, Berl., 
1907, ix, 361. 

Jambon, A. — Syphilis tertiaire pre- 
coce avec presence dans des ul- 
cerations amygdaliennes de 
fuso-spirilles de Vincent et de 
treponema pallida de Schaudinn 
— Bull. Soc. med. d. Hop. de 
Lyon, 1907, vi, 53. 

Jambon, A. — Spirochetes de Schaud- 
inn dans les lesions tertiaires — 
Bull. Soc. med d. hop. de Lyon, 
1907, vi, 143-145. 

Jambon, A. — Syphilis tertiaire pre- 
coce avec presence de fuso- 
spirilles de Vincent et de tre- 
ponema pallida de Schaudinn — 
Lyon med., 1907, cviii, 474. 

Jambon, A. et Nicolas — Chancres 
bipolaires scrotal et gingival — 
Lyon med., 1908, ex, 136-140. 

James, G. B. — A ease of syphilis 
with an unusually long incuba- 
tion period — Lancet, Lond., 
1909, ii, 711. 

Jamieson, W. A. — Case of extensive 
tertiary serpiginous eruption — 
Tr. Med. Chir. Soc, Edinb., 
1905, xxiv, 51. 

Jancke — Ueber eytorrhyctenbefunde 
— Miinchen med. Woch., 1905, 
lii, 2183. 

Jancke — Die spirochete pallida und 
der cytorrhyktes luis — Therap. 
Monatsch., Berl., 1908, xxii, 79- 
89. 

Jansen, H. — Histologisehe unter- 
suchung der durch Kromayer's 
quecksilberquarzlampe erregten 
entziindung — Arch. f. dermat. 
u. syph., Wien u. Leipz., 1908, 
xc, 53-66, 1 pi. 

Japha — Fall von krampfen auf lue- 
tischer basis — Deutsche med. 
Wochnschr., 1905, xxxi, 281. 

Jaworski, W. u. Lapinski, St. — 
Ueber das sehwinden der Was- 
s e r m a n n -Neisser-Bruckschen 
reatkion bei syphilitischen 
erkrankungen und einige strit- 



344 



Recent Bibliography. 



tige punkte derselben — Wien. 
klin. Woch,., 1909, xxii, 1442- 
1445. 

Jeanne — Sur le diagnostic de la 
syphilis testiculaire — Norman- 
die med., Rouen, 1905, xx, 175. 

Jeanselme, E. — Demonstration der- 
matologiques les sypbilitiques 
— Rev. gen. de clin. et de 
therap., Paris, 1906, xx, 385- 
388. 

Jeanselme. E. — Les syphilis ma- 
lignes — Rev. gen. de clin. de 
therap., Paris, 1905, tome xix, 
453. 

Jeanselme, E. — Lymphangite specif- 
ique de la verge — J. de med. 
int., Paris, 1907, xi, 51. 

Jeanselme, E. — Syphilides papu- 
leuses tardives — J. de med. int., 
Paris, 1907, xi, 53. 

Jeanselme, E. — Gomme syphilitique 
ou bacillaire — J. de med. int., 
Paris, 1907, xi, 53. 

Jeanselme. E. et Sezary, A. — Lymph- 
ocytic cephalo-rachidienne et 
formule sanguine chez les syph- 
ilitiques — Compt. rend. soc. de 
biol., Palis, lxiv. -2111-203. 

Jeanselme, E. — Des chancres extra- 
genital^ — Gaz. d. hop., Paris, 
1906, lxxix, 627-632. 

Jeanselme — Exostoses 42 ans apres 
la chancre — Rev. internat. de 
med. et de ehir.. Paris. 1909, xx, 
122. 

Jeanselme — Syphilide psoriasiforme 
diagnostic — Rev. internat. de 
med. et de ehir., Paris, 1909, xx, 
121. 

Jeanselme — Heredo-syphilis et arth- 
rite — Rev. gen. de clin. et de 
therap., Paris, 1909. xxiii, 248. 

Jeanselme — Heredo-syphilis et syphi- 
lis acquise — Rev. gen. de ehir 
et de therap., Paris, 1909, xxiii, 
342. 

Jeanselme — Gommes sypbilitiques — 
Rev. gen. de clin. et de therap., 
Paris, 1909, xxiii, 454. 

Jeanselme — Les dystrophies den- 
taires de rheredo-svphilis — Rev. 
gen. de clin. et de therap., 
Paris, 1909, xxiii, 598. 

Jeanselme — Syphilis extra-genitale 
Rev. gen. de clin. et de therap., 
Paris, 1909, xxiii, 733-740. 

Jeanselme — Chancre mou primitit 
du doigt — Bull, med., Paris, 
1909, xxiii, 657-659. 



Jennings, W. B. — Congenital syph- 
ilis— N. Y. M. J., 1907, lxxxvi, 
645. 

Jenny — Trois cas de syphilis par 
tatouage — Arch, de med. et 
pharm. mil., Paris, 1907, 1438. 

Jensen, V.— Om fund af spirochaete 
pallida (Schaudinn) — Hosp- 
Tid., Kobenh., 1905, 4 R xiii, 
559. 

Jesionek et Meirowsky — Die prak- 
tiscbe bedeutung des W'asser- 
mann - A. Neisser - Bruckschen 
reaktion — Miinchen med. Woch., 
1909, lvi, 2297-2300. 

De Jesus, Gonzales, J. — Frecuencia 
de la sifilis hereditaria occular 
y estudio de sus estigmas rudi- 
mentaires — An. de oftal., Mex- 
ico, 1907-8, x, 339-366, 1 pi. 1 
tab. 

Joannides — Trois cas de syphilis — 
Ann. d. mal. ven. Paris, 1909, 
iv, 429. 

Jochmann u. Topfer — Zur frage der 
spezifizitiit der komplement- 
bindungsmethode bei der syph- 
ilis — .Miinchen med. Woch., 
1908, lv. lli!IO. 

John, F. — Reinfecto syphilitica zu- 
sammenstellung kritische bewer- 
tung und statistiscbe ergebnisse 
von 356 in der welt-literatur 
vi'i.'.ffent lichen reinfektionsfal- 
bii. nebst einer sammlung von 
meinungsiiusscrungen bekannter 
autoren — Samml. klin. Vortr., 
Lcipz... 1909. n. F. No. 525-532. 
(Inn. Med., No. 157-164, 559- 
808). 

Johnson, L. W. — The oral manifesta- 
tions of syphilis — Dental Cos- 
mos, Phila., 1909, li, 50-55. 

Joltrain, E. — Sero-diagostic de la 
syphilis — Ann. d. mal. veri., 
Paris. 1909, iv., 583-636, incl. 
2 pi. 

Joly, J. — Syphilome cylindroide de 
l'urethre — Ann. soc. mid-chir. 
de Liege, 1905, xliv, 350-357. 

Jones, H. E. — Gummatous and pha- 
gadenic ulceration of the skin 
and mucous membrances in in- 
herited svphilis — Brit. J. Child. 
Dis., Lond., 1908, v, 144-152. 

Jordan. A. — Syphilis among mar- 
ried women and in families — 
Med. Obozr.. Mosk., 1908, lxx, 
735-739. 



Recent Bibliography. 



345 



Jordan, A — Ein beitrag zur frage 
der praktischen bedeutung der 
Wassermannsehen reaktion bei 
syphilis — Monatsh. f. prakt. 
Dei-mat, Hamb., 1909, xlix, 339- 
348. 

Jordan, A. — Ueber die syphilis der 
frauen und der familien — Der- 
mat. Ztschr., Berl., 1908, xv, 
560-565. 

Jordan, A. — Zur statistik der ter- 
tiaren syphilis in Moskau — 
Arch. f. Dermat. u. Syph., Wien 
u. Leipz., lxxxiii, 353-372. 

Di Jorio, M. — Le piu importanti e 
reeenti richerche sulla sifilide — 
Gazz. internaz. di med., Napoli, 

1905, viii, 395. 

Joseph, M. — Die bedeutung der 
serumdiagnostik fur die con- 
genitale lues — Arch. f. Kin- 
derh., Stuttg., 1909, 1, 164-167. 

Jousset, A. et Paraskevopoulos, P. 
P. — De la variabilitie du com- 
plement et des causes d'erreur 
dans le syphilo-diagnostic par 
la reaction de fixation — Compt. 
rend. soc. de biol., Paris, 1909, 
Ixvi, 22-24. 

Jouty, A. — Lesion syphilitique her- 
editaire tardive de la voute 
palatine des fosses nasales et 
du pharynx buccal ayant amene 
par la reparation des tissus des 
deformations accentuees et 
rares — Ann. d. mal. de l'oreille 
du larynx, Paris, 1907, xxxiii, 
231. 

Juliusberg, F. — Beitrag zur kennt- 
nis der syphilides posterosives 
— Arch. f. Dermat. u. Syph., 
Wien. u. Leipz., 1909, xcviii, 
91-100, 1 pi. 

Juliusberg, M.- — Spirochseten beim 
spitzen kondylom — Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz., 1907, lxxxiv, 319. 

Jullien et Stassano — Cinq cas de 
gommes traitees par le levurar- 
gyre — Progres med., Paris, 

1906, 3 s., xxii, 245. 

Jullien, L. — Sur un cas de syphilis 
accompagne de vertiges — Bull, 
med., Paris, 1907, xxi, 64. 

Jundell, J., Alnkoist, J. and Sand- 
mann, F. — A few experiences 
with Wassermann's serum-reac- 
tion in syphilis — Hygeia, Stock- 
holm, 1909, 2 f. ix, 193-215. 



Justus, J. — The treatment of syph- 
ilis — Gyogyaszat, Budapest, 
1907, xlvii, 398-400. 



K 

Kanitz, H. — A leukoderma syphiliti- 
cum — Gyogyaszat, Budapest, 

1908, xlviii, 802; 826; 847; 

1909, xlix, 72; 124; 138; 154. 
Kanitz, H. — Onychia et paronychia 

syphilitica — Orvosi hetil, Buda- 
pest, 1907, li, 252. 

Kappelhoff, A. — De serumreactie 
van Klausner als herkenning- 
smiddel van syphilis — Nederl. 
Tijdschr. v. Geneesk., Amst., 
1908, ii, 1777-1779. 

Karewski, F. — Ueber die bedeutung 
der Wassermann'schen syphilis- 
reaktion fur die chirurgische 
differentialdiagnose — Berl. klin. 
Woch., 1908, xlv, 15-18. 

Karvonen, J. J. — Syphilitic dacty- 
litis — Duodecin Helsinki, 1905, 
xxi, 111-134. 

Karvonen, J. J. — Zur kenntnis der 
sog. dactylitis syphilitica — Arb. 
a. d. path. Inst. d. Univ. Hel- 
singfors, Berl., 1905, i, 293- 
312, 2 pi. 

Karwacki, L. — Morphology of the 
spirocheta pallida — Gaz. lek., 
Warszawa, 1906, 2 s. xkvl, 1157. 

Kayser — Fievre syphilitique ter- 
tiaire — Syphilis, Paris, 1905, 
iii, 22. 

Keenan, C. B. — Spirochseta pallida — 
Montreal M. J., 1905, xxxiv, 
889. 

Keimer, P. — Beitrag zur syphilis 
der oberen luftwege — Ztschr. f. 
arztl. Fortbild, Jena, 1905, ii, 
676. 

Kelly, A. E. — The diffuse hyperplas- 
tic laryngitis and pharyngitis 
of congenital syphilis — Glasgow 
M. J., 1906, lxvi, 338-345. 

Kennedy, S. R. M. — A case of mul- 
tiple chancres — J. Am. M. Ass., 
Chicago, 1906, xlvi, 1353. 

Kenney, F. W. — Congenital syphilis, 
with report of a case — 'Colorado 
Med., Denver, 1908, v, 197-201. 

Kentzter, G. and Orszag, O. — The 
clinical importance of the syphi- 
litic reaction by the method of 
Porges and Meyer — Orvosi 
hetil.. Budapest, 1908, lii, 367- 
369. 



346 



Recent Bibliography. 



Kerr, Le G. — The diagnosis of con- 
genital syphilis in the first 
weeks of life — N. York M. J., 
1909, xe, 165-168. 

Kevroletf, F. — Development of syph- 
ilis and venereal diseases along 
the Siberian railroad in 1902-3, 
and preventive measures — Si- 
birsk vrach viedom, Krasnoy- 
arsk, 1905, iii, 137, 153, 171, 
188. 

Keyes, E. L., Jr. — Syphilis as a 
cause of depopulation and race 
deterioration — J. Am. M. Ass., 
Chicago, 1907, xliv, 453-457. 

Keysselitz, G. — Spirocha-ta anodo- 
nate nov — spec. Arb. a. d. k. 
Gandhteamte., Berl., 1906, xxiii, 
506-569, 2 pi. 

Khitrovo, A. A. — The simplest 
method of presenting the spiro- 
cheta pallida in 6mear-cultures 
Rusk. Vrach., S. Peterb., 1909, 
viii. 875. 

Khmielnitski, M. A. — Serum diag- 
nosis of syphilis — Prakt. Vrach., 
S. Peterb., 1908, vii, 728-741- 
762. 

Kikuti — Syphilitic influenza — Nip- 
pon Gakwai Zasshi, Tokyo, 
1906-7, iii, 24-32. 

Kimenko, W. N. — Bacillus flavo-au- 
rantius sporogenes (nov spec) 
aus dem antisyphilitischen se- 
rum de Lisle— -Centralbl. f. 
Bakteriol.. 1 Abt., Jena, 1906, 
xlii. 221-225. 

Kimla, R. — Latent congenital hypo- 
plasia of the glandular organs 
dependent on congenital syph- 
ilis — Casop. lek. cesk. v. Praze. 
1905. xliv. 523, 557, 585. 621, 
650, 682. 710, 741, 770, 796, 
S27. 849. 882, 900, 929, 952, 
975. 998. 12 pi. 

Kimla, R. — Spirochete pallida 
( Schaudinn-Hoffmann) and its 
significance in the etiology of 
syphilis — Casop. lek v. Praze, 
1905. xliv. 1204, 1234, 1272. 

Kimla. R. — Konigenitale latente hy- 
ploplasien der drusigen organe 
bei der konigenitalen syphilis — 
YYien med., Woch., 1905, lv, 
1541, 1585, 1629, 1668. 1715, 
1798. 1832, 1878, 1927, 1982, 
2028, 2074, 2114, 2161, 2210, 
2253. 2303. 2350, 2401, 2479. 

Kimla, R. — Syfilis experimentalna — 
Casop. lek. cesk. v. Praze, 1906, 
xlv, 309-311-340-378. 



Kimla, R. — Spirochete pallida and 
its significance in syphilis — 
Casop. lek. cesk. v, Praze, xlv, 
432-435. 

Kinch, C. A. — Acquired syphilis in 
children — Pediatrics, N. Y., 
1908, xx, 163-167. 

Kindborg, L. et Mondor, H. — Note 
sur un cas d'ichtyose chez une 
enfant de dix ans syphilitique 
hereditaire presentant des phe- 
nomenes dementiels de la rigi- 
dite pupillaire et de la para- 
plegie spasmodique — Bull, et 
mem. Soc. med. d. hop., Paris, 
1908. 3 s. xxv, 556-560. 

King. J. M. — History of syphilis — 
South. Pract., Nashville, 1908, 
xxx, 7-17. 

King, W. P. — The origin of syph- 
ilis tertiarj syphilio so-called 
not syphilis — Am. Med., Phila., 
1906, ns. i. 246-248. 

King. W. P. — The relation of syph- 
ilis to cancer of the mucous 
membrane — St. Louis Cour. 
Med., 1906, xxxv, 29-36. 

Kingsbury, J. — Chancre of the cheek 
following a bite — J. Cutan. 
Dis., incl. Syph., N. Y., 1907, 
xxv, 356. 

Kingsbury, J. — Clinical notes on 
syphilis; labial chancres — J. 
Am. M. Ass., Chicago, 1907, 
xlviii, 1863. 

Kingsbury, J. — Case of Fordyce's 
disease, with labial chancre — 
Am. J. Dermat. and Genito- 
Urin. Dis.. St. Louis, 1908 xii, 
383. 

Kingsbury. J. — < ase of relapsing 
labial chancre — Am. J. Dermat. 
and Genito-Urin. Dis., St. Louis, 

1908. xii. 3S4. 

Kingsbury — Palmar syphilide — J. 
Cutan. Dis. incl. Syph., N. Y., 

1909, xx vii. 407. 
Kiolemenoglou, B. u. Von Cube, F. — 

Spirochete pallida (Schaudinn) 
und svphilis — Munehen med. 
Woch.,"l905. Iii. 1275. 

Kirkpatrick. A. B. — Syphilitic com- 
plications of the nose and 
throat — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1906, x, 198-204. 

Kisel, A. A. — Tubercular syphilis 
combined with mechanical irri- 
tation — Russk. j. kozhn. i. ven. 
boliezn, Kharkov, 1905, ix, 325. 



Recent Bibliography. 



347 



Kistyakovski, E. V. — Diseases of 
veins in syphilis — Voyenno- 
med. J., St. Petersb., 1906, 
ccxvi, 305-307. 

Klausner, E. — Ergebnisse mit der 
von mir angegebenen prazip- 
itationsreaktion bei syphilis — 
Prag. med. Woch., 1908, xxxiii, 
675. 

Klausner, E. — Vorliiufige mitteilung 
ueber eine methode der serum- 
diagnostik bei lues — Wien klin. 
Woch., 1908, xxi, 214. 

Klausner, E. — Eine methode der 
serumdiagnostik bei lues — 
Wien klin., Woch., 1908, xxi, 
363. 

Klausner, E. — Klinische erfahrun- 
gen ueber das prazipitations- 
phanomen mit distilliertem 
wasser in serum syphilitischer 
—Wien klin. Woch., 1908, xxi, 
940. 

Klein, K. — Klinisches und morpho- 
logisches material zur aetiolo- 
gie der syphilis — Mitt. a. d. 
H a m b . Staatskrankenannst, 
1908, viii, 347-361, 6 pi. 

Klein, K. — Klinisches und morpho- 
logisches material zvir aetiologie 
der syphilis — Jahrb. d. Hamb. 
Staatskrankenannst, 19 7, 
Hamb. u. Leipz., 1908, xii, pt. 
2, 347-361. 

Kleinwachter, L. — Einige worte zur 
streitfrage ueber die herkunft 
der lues — Janus, Amst., 1905, 
x, 246. 

Klieneberger, C. u. Zoeppritz, H. — 
Beitrage zur frage der bildung 
spezifischer leukotoxine im blut- 
serum als folge der Rontgenbe- 
strahlung der leukamie, der 
pseudoleukamie und des lyrn- 
phosarkoms — Munchen, med. 
Wehnschr., 1906, liii, 850. 

Klotz, H. G. — A case of re-infection 
of syphilis — Tr. Am. Dermat. 
Ass., N. Y., 1904, xxviii, 83-92. 

Klotz, H. G. — Remarks on syph- 
ilitic alopecia — J. Cutan. Dis. 
incl. Syph., N. Y., 1907, xxv, 
99-108. 

Klotz, H. G. — Wirklicher und ver 
meintlicher haarverlust bei 
syphilis — N. York med, 
Monatsehr., 1907,, xix, 257-263 

Klotz, H. G. — Wirklicher und ver- 
meintlicher haarverlust bei 
syphilis — Allg. Wien med. Ztg. 
1908, liii, 351, 363. 



Klotz, H. G. — Multiple dactylitis 
syphilitica (phalangitis heredo- 
syphilitica Hochsinger) in an 
infant — J. Cutan. Dis. incl. 
Syph., N. Y., 1909, xxvii, 238- 
241. 

Knapp — Syphilitische sensibilitiits- 
storungen am rumpfe — Arch. f. 
Psychiat., Berl., 1906, xii, 737- 
745. 

Knauer — Negative d i a g n o s e — 
Miinehen med. Woch. 1906, liii, 
2539. 

Knoepfelmaeher, W. u. Lehndorff, 
H. — Komplementfixation bei 
muttern heredo-syphilitischer 
sauglinge 2 mitteilung — Med. 
Klin., Berl., 1908, iv, 1182-1184. 

Knoepfelmaeher, W. u. Lehndorff, 
H. — Hydrocephalus chronicus 
internus congenitus und lues — 
Med. Klin., Berl., 1908, iv, 1863- 
1865. 

Knoepfelmaeher, W. u. Lehndorff, 
H. — Komplementablenkung bei 
muttern hereditarleutischei 

sauglinge — Wien med. Woch., 
1908, lviii, 609-613. 

Knoepfelmaeher, W. u. Lehndorff, 
H. — Komplementablenkung bei 
muttern hereditarluetischer 
sauglinge — Mitt. d. Gesellsch. f. 
inn. med. u. kinderh. in Wien, 
1908, vii, 82-87. 

Knoepfelmaeher, W. u. Lehndorff, H. 
— Das Collessche Gesetz — Med. 
Klin., 1909, 1506-1508. 

Knoepfelmaeher, W. u. Lehndorff, H. 
— Untersuchungen heredolue- 
tischer kinder mittelst der Was- 
sermann'schen reaktion ; das 
gesetz von Profeta — Wien. med. 
Woeh., 1909, lix, 2230-2237. 

Knott, J. — The origin of syphilis 
and the invention of its name 
— N. York M. J., 1908, lxxxviii, 
817-822. 

Knowles, F. C. — Multiple chancre; 
report of a case with five in- 
itial lesions on the penis — N. 
York M. J., lxxxiv, 1126. 

Knowles, F. C. — Extra-genital and 
urethral chancre; report of five 
eases, including one with mul- 
tiple lesions of the breast; — J. 
Am. M. Ass., Chicago, 1906, 
xlvi, 1351. 

Knowles, F. C. — Syphilis extra-geni- 
tally acquired in early child- 
hood— N. York M. J., 1908, 
lxxxviii. 108-111. 



348 



Recent Bibliography. 



Koch. M. — Ueber einen spirochaten- 
befund bei kavernoser lungen- 
syphilis und pachymeningitis 
hemorrhagica interna produc- 
tive — Verhandl. d. deutsch. 
path. Gesellsch., 1907, Jena, 

1908, xi, 276-282, 1 pi. 
Koch, T. — Ueber das wesen und die 

technik der Wassermannschen 
sero-diagnostischen untersuch- 
ungenmethode der svphilis — 
Apoth-Ztg.. Berl., 1909, xxiv, 
910. 

Koehler, H. H. — The present status 
of the etiology of syphilis — 
Louisville M. J., 1908, xv, 47-52. 

Koenig, C. J. — An error in diagnosis 
maintained by microscopical ex- 
amination— X. York M. J., 1909, 
xc. 310. 

Kohler, A. — Typische Rontgeuo- 
gramme von knochengummen — 
Fortsehr. a. d. Geb. d. Rontgen- 
strahlen, Hamb. 1906. x, 73 77. 
2 pi. 

Kohn. E. — Ein fall von infection 
in utero — Med. Klin.. Rerl., 

1909, v. 1192. 

Kohn, J. — Ueber die Klausnersche 
serum reaktion — Wien klin. 
Woch., 1909, xxii, 633-635. 

Kolomoitsefl, S. V. — Case of prob- 
able syphilitic re-infection — 
Russk. Yrach. S. Ptersb., 1907, 
vi. 373. 

Konig — Warum ist die Hechtsche 
modification der Wassermann- 
schen luesreaktion dieser und 
der Sternsehen modifikation 
vorzuziehn ? — Wien. klin. Woch., 
1009, xxii, 1127-1129. 

Konigstein — Zwei fiille bei denen 
eine kombination von lues und 
tuberkulose vorkam — Mitt. d. 
Gesellsch. f. inn. med. u. Kin- 
derh.. Wien, 1909, riii. 108. 

Konkle. W. B. — Voltaire on syphilis 
— Med. Libr. and Hist. J.. 
Brooklyn, 1905, iii, 117-127. 

Kopp, C. — Ueber die bedeutung der 
Wassermannschen sero-diagnose 
der syphilis fur die praxis — 
Miinchen med. Woch., 1909. Ivi, 
957-959. 

Korte, W. E. — On certain bodies 
present in the chancre in the 
condyloma and in the blood dur- 
ing secondary syphilis — Practi- 
tioner, Lond., 1906, lxxxvi. 
786-790, 4 pi. 



Kossa, G. — Endemic syphilis in Hun- 
gary — Gyogyaszat, Budapest, 
1905. xlv. 711, 729. 

Kowaleski — Ueber primarafl'ekt am 
lid mit demonstration von spi- 
rochaten — Deutsche med. Woch., 
Leipz. u. Berl., 1905, xxxi, 2098- 
2101. 

Kowalewski — Ueber primarafl'ekt 
am lid mit demonstration von 
spirochieten — Verhandl. d. Berl. 
ophth. Gesellsch., 1905, Leipz., 
1900, 12. 

Kraus, R. — Ueber experimentelle 
syphilis bei affen — Med. Bl., 
Wien u. Leipz., 1905. xxviii, 99. 

Kraus, R. — Ueber die aetiologie be- 
deutung der spirochete pallida 
— -Wien klin. Woch.. 1905. xviii, 
592. 

Kraus, R. u. Prantschoff, A. — Ueber 
das konstante vorkommen der 
spirouhipta pallida in syphilit- 
schen gewebe bei menschen und 
alien — Wien klin. Woch., 1905, 
xviii. 941. 

Kraus, R. — Zur aetiologie. patholo- 
gie und expeiimentellen thera- 
pie der syphilis — Wien klin. 
Woch.. 1905, xviii, 1052. 

Kraus, R. — Bemerkungen zu dem 
aufsatze des Dr. A. Brand- 
weiner versuche ueber aktive 
immunisierung bei lues — Wien 
klin. Woch.. 1905, xviii. 1246. 

Kraus. A. — Mitteilungen ueber spi- 
rochetenuntersuchungen an der 
klinik des Hofrates Pick — Prag. 
med. Woch., 1906, xxxi, 354. 

Kraus, A. — Spirochatenuntersuch- 
ungen — Deutsche med. Woch.. 
Leipz. u. Berl., 1906 xxxii, 
1478. 

Kraus, A. — Zur technik der spiro- 
chatenfarbung — Miinchen med. 
Woch., 1906. liii, 2568. 

Kraus. A. — Untersuchungen ueber 
spirochete pallida — Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz., 1906, lxxxii. 39-48. 

Kraus, R. u. Volk. R. — Versuche 
ueber die immunitat bei syph- 
ilis und bei vaccine — Verhandl. 
d. deutsch. dermat. Gesellsch., 
Berl., 1907, 242-249. 

Kraus. R. u. Volk, R. — LTeber gen- 
eralisierte syphilis bei niederen 
affen — Sitzungsb. d. r. akad. d. 
Wissensch. Math-Naturw. Kl., 
Wien. 1909, cxviii, 3-14 1 pi. 



Recent Bibliography. 



349 



Kraus, R. — Studien ueber immuni- 
tat und iitiologische therapie 
der syphilis — Sitzungsb. d. k. 
Akad. d. Wissensch. Math. 
naturw. Kl., Wien, 1905, cxiv, 
3 Abt., 547-56S. 

Krefting, R. — How long does the 
virus of syphilis remain infec- 
tious? — Norsk Mag. f. Laege- 
vidensk, Kristiania, 1905, 5 R. 
iv, 628. 

Kreibich, C. — Klinik und prophylaxe 
der syphilis — Prag. med. Woch., 

1906, xxxi, 627. 

Kreibich, C. — Einige seltene falle 
unformen der lues — Med. Klin., 
Berk, 1907, iii, 1577-1580. 

Kreibich, C. — Klinik und prophy- 
laxie der syphilis — Deutsche 
Aerzte. Ztg., Berk, 1907, 50. 

Kretschmer, W. — Lymphocytose des 
liquor cerebrospinalis bei lues 
hereditaria tarda — Deutsche 
med. Woch., Leipz. u. Berk, 

1907, xxxiii, 1901-1903. 
Krienitz, W. — Ueber morphologische 

veranderungen an spirochaten — 
Centralbl. f. Bakteriok, 1 Abt., 
Jena, 1906, xlii, 43-47. 

Von Krogh, M. — On the so-called 
serum diagnosis of syphilis — 
Tidsskr. f. d. norske Laegefor, 
Kristiania, 1908, xxviii, 786- 
793. 

Kroner, K. — Ueber der differentiell- 
diagnostischen wert der Wasser- 
mann'schen serodiagnostik bei 
lues fiir die innere medizin und 
die neurologie — Berk klin. 
Woch., 1908, xlv, 149-151. 

Krzysztalowicz, F. and Siedlecki, M. 
— Schaudinn's spirochaete in 
syphilitic changes — Przegl. lek, 
Krakow, 1905, xliv, 497-500. 

Krzysztalowicz, F. u. Siedlecki,, M. — 
Spirochete pallida Schaudinn 
in syphilitischen erscheinungen 
— Monatsch. f. prakt. Dermat., 
Hamb., 1905. xli, 231-240. 

Krzysztalowicz, F. u. Siedlecki,, M. 
— Ueber das verhaltnis des ent- 
wisklungszyklus des treponema 
pallidum Schaudinn zu den 
syphilitischen krankheitsstadien 
— Monatsch. f. prakt. Dermat. 
Hamb., 1906, xliii, 1-12. 

Krzysztalowicz, F. and Siedlecki, M. 
— Relationship of the develop- 
ment of treponema to the stages 
of syphilis — Przegl. lek, Kra- 
kow, 1906, xlv, 303-307. 



Krzysztalowicz, F. and Siedlecki, M. 
— Contribution a l'etude de la 
structure et du cycle evolutif 
du spirochete pallida de 
Schaudinn. (From Bull, de 
L'Aoad. d. sc. de Cracovie — Rev. 
prat d. mal. cutan., Paris, 1906, 
v, 43-56, 2 pi. 

Krzysztalowicz, F. u. Siedlecki,, M. 
— Experimental study of syph- 
ilis; morphology of the spiro- 
cheta pallida — Rozpr. wydz. 
maternat-przyr. Akad. umiej., 
Krakow, 1907, 3 s. vii B. 705- 
758, 2 pi. 

Krzysztalowiecz, F. u. Siedlecki, M. 
— Das verhalten der spirochaeta 
pallida in syphilitischen effores- 
zenzen und die experimentelle 
syphilis — Monatsch. f. prakt. 
Dermat., Hamb., 1908, xlvi, 423- 
435. 

Kudish, V. M. — Hereditary syphilis 
with secondary epididymitis — 
Russk. j. kozhn. i. ven boliezn, 
Kharkov, 1906, xi, 259. 

Kudish, V. M. — Two cases of pro- 
fessional syphilitic infection; 
syphilis of the innocent — Russk. 
j. kozhn. i. ven. boliezn, Khar- 
kov, 1907, xiii, 35-37. 

Kurita, S. — Tiitowierung und syph- 
ilis. (Ausz., pt. 2, 13) (Japan- 
ese text) — Hifubyog. kiu Hini- 
okibyog, Zasshi, 1905, v, 578. 

Kurita, S. — Tiitowirung and syph- 
ilis (Japanese text Uebers Hft. 
17) — Mitt. d. med. gesellseh. zu 
Tokyo, 1905, xix, 775-790, 1 pi. 

Kurkovski, I. P. — Fever in visceral 
syphilis — Izviest. Imp. Voyenno- 
Med. Akad., S. Petersb., 1909, 
xviii, 267-294. 

Kuster, E. — Die serodiagnosis der 
lues — Aezrtl. Mitt, a Baden 
Karlsruhe, 1908, Ixii, 147-150. 

Kuttner, H. — Fall von einseitiger 
sabelscheidenverkrummung der 
tibia auf luetischer basis — 
Munchen med. Woch., 1905, lii, 
290. 



Labbe, M. — Anemie pernicieuse 
d'origine syphilitique — Presse 
med., Paris, 1906, xiv, 841. 

Lacapere — La leucoplasie etiologie et 
pathogenie syphilis et leucopla- 
sie rapports de la leucoplasie 
avec la plaque maqueuse recidi- 



350 



Recent Bibliography. 



vante — Arch. Gen. de rued., 
Paris, 1905, tome i, 1031-1041. 

Lacapere et Ravard — Gommea gan- 
glionnaires dans la syphilis ac- 
quise — Bull. Soc. franc, de der- 
mat. et svph., Paris, 190S, xix, 
332-334. 

Lacapere et Merle, P. — Hemianopsie 
au cours de la syphilis — Ann. d. 
mal. ven., Paris, 1909, iv, 115- 
118. 

Laffont — Gomme de l'amygdale 
gauche syphilis maligne precoce 
— Ann. d. mal. ven., Paris, 1906, 
ii. 111. 

Laffont — Syphilide tertiaire chan- 
criforme du fourreau de la 
verge gale ancienne simulant 
une roseole ictere infectieux 
benin prolonge — Ann. d. mal. 
ven.. Paris, 1907, ii, 369. 

Laffont. P. — La syphilis tertiaire ac- 
quise ou hereditaire de Tuterus 
et de ses annexes — Ann. d. mal. 
ven.. Paris. 1909. iv, 1-48. 

Lamalle, A. — Sur la seroreaction de 
la syphilis — Scalpel, Liege, 
1909-10. lxii, 141. 

Lamb, D. S. — Case of syphilis of 
liver and other organs — Wash. 
M. Ann., 1909-10, viii, 290. 

Lambkin. F. J. — Syphilis in the 
Uganda Prectorate — J. Roy. 
Army Med. Corps Lond., 1908, 
xi. 149-163. 

Lambkin, F. J. — Physical degener- 
ation and syphilis — Brit. M. J.. 
Lond., 1905", ii. 375. 

Lamnois, P. E. et Laederich, L. — 
Association de spirilles et de 
bacilles fusiformes de Vincent 
dans iin chancre syphilitique a 
tendance phagedenique — Bull. 
et mem. Soc. med. d. H. d.. 
Paris. 1905, 3 s. xxii, 601. 

Landois. F. — Ueber das vorkommen 
vnn Langhaus'schen riesenzellen 
bei der syphilis der querge- 
streiften muskulatur und ihre 
verwertung fur die diagnostik 
— Beitr. z. klin. Chir.. Tubing, 
1909. lxiii. 315-336. 1 pi. 

Landouzy. L. — Sur la frequence de 
la syphilis — J. de med. et chir. 
prat, Paris, 1906. Ixxvii. 573- 
575. 

Landouzy, L. et Troisier, J. — Affec- 
tions vasculaires congenitales 
d'heredo-syphilitiques — Bull. 
Acad. de'Med., Paris, 1907, 3 
s. lviii, 370-380. 



Landouzy, L. et Laederich, L. — Af- 
fections cardiovasculaires con- 
genitales d'heredo-syphilitiques ; 
etude de pathologie generale — 
Bull. Acad. d. Med., Paris, 1907, 
3 s. Mi, 671-691. 

Landouzy. L. — Nosographie pathol- 
ogie generale diagnostique de 
1'heredo-syphilis tardive peda- 
gogie medicale — Presse med., 
Paris, 1907, xv, 225. 

Landsteiner, K. — Untersuchungen 
ueber syphilis an affen — 2 Mit- 
teilungen Sitzungsb. d. k. Akad. 
d. Wissenseh. Math-naturw. Kl., 
Wien, 1906, cxv, 3 Abt., 179- 
199. 

Landsteiner, K. u. Finger — Ueber 
immunitat bei syphilis — Cen- 
eralbl. f. Bakteri'ol., 1 Abt., 
Jena, 1906, xxxviii, 107. 

Landsteiner, K. u. Mucha, V. — Zur 
technik der spirochstenunter- 
suchung — Wien Klin. Woch., 

1906, xix. 1349. 
Landsteiner, K. u. Muller, R. u. 

Potzl, 0. — Zur frage der kom- 
plementbindungsreaktionen bei 
syphilis — Wien klin. Woch., 

1907, xx. 1565-1567. 

Lane, J. E. — A review of some re- 
wiit work on syphilis — Practi- 
tioner, Lond., 1905, lxxv, 193- 
202. 

Lang — Fall von gummoser ostitis 
des schadeldaches mit ausgang 
in nekrose — Wien klin. Woch., 
1906, xix. 1531. 

Lang, E. — Die spirochaete pallida 
und die klinische forschung 
nebst betraehtungen ueber syph- 
ilistherapie auf grund der .tung- 
sten forschungsergebnisse — 
Wien klin. Wchnschr., 1908, 
x\i. 1653-1709. 

Lanzafame, S. — La spirochete pal- 
lida nplle les'oni sifilitiche, con 
speciale riguardo all'azione 
della cura mercuriale su di essa 
— Gazz. sicil. di med. e chir., 
IVrimo, IDi'J, v, 2O&-207. 

De Lapersonne, F. — Syphilis heredi- 
taire et ophtalmoloplegie in- 
terne — Rev. neurol., Paris, 
1909. xvii, 363. 

Lapowski. N. — Ervthama recidivans 
urticans faciei in a hereditary 
syphilitic subjects — J. Cutan. 
Djs. incl. Syph., N. Y.. 1908, 
xxvi. 187. 



Recent Bibliography. 



351 



Lapowski, B. — The recent investiga- 
tions in syphilis and their prac- 
tical application — N. York M. 
J., 1907, Ixxxv, 735. 

Laquerriere — Possible influenza 
della corriente ad alta fro- 
quenza e dei raggi X sopra una 
gomma sifilitica — Gior. di elett 
med., Napoli, 1906, vii, 13. 

Laub, M. u. Novotny, J. — Ueber die 
brauchbarkeit der progresschen 
ausflockungsreaktion fiir die 
diagnose der lues an leichen — 
Ztschr. f. Immunitiitsforsch. u. 
exper. Therap., Jena, 1909, iii, 
394-400. 

Laufer, R. — Les reserches sur la 
vaccination et la serotherapie 
antisyphilitiques — Rev. scient., 
Paris, 1905, 5 s. iv, 810. 

Laurent, L. — Syphilis ignoree mye- 
lite specifique 44 ans apres 
l'accident initial — Normandie 
med., Rouen, 1908, xxiv, 234- 
236. 

Law, H. — A clinical lecture on ter- 
tiary syphilis in upper air pas- 
sages — Med. Press and Circ, 
Lond., 1909, ns. lxxxvii, 290. 

Lazareff, V. G. — On syphilitic ter- 
tian fever case — Kussk. j. 
kozhn. i. ven. boliezn, Khar- 
kov, 1908, 289-297. 

Lebially, C. — Multiplication in vitro 
du treponema pallidum Sehaud- 
inn — Compt. rend. Acad. d. sc. 
Paris, 1908, cxlvi, 312-314. 

Lecha-Martinez, L.- — La avariosis 
como enfermedad social — -Rev. 
espan, de dermat. y sif., Ma- 
drid, 1908, x, 8, 50, 145. 

Lecha-Marzo, A. — La sifilis en la 
descendencia higiene de los 
heredo-sifiliticos — Rev. espan. 
de dermat. y sif., Madrid, 1909, 
xi, 196-1441. 

Ledermann, R.— Ueber den prak- 
tischen wert der serodiagnostik 
bei syphilis — Deutsche med. 
Woch., Leipz., u. Berl., 1908, 
xxxiv, 1760-1763. 

Ledermann, R. — Ueber die technik 
der serumdiagnostik bei lues 
nebst allgemeinen bemerkungen 
ueber ihren wert in der arzt- 
lichen praxis — Ztschr. f. arztl. 
Fortbild, Jena, 1909, vi, 220- 
225. 

Ledermann, R. — Ueber die bedeutung 
der Wassermannschen serum- 



reaktion fiir die diagnostik und 
behandlung der syphilis — Med. 
Klin., Berl., 1909, v, 419-423. 

Ledoux, E. — Syphilis ignoree — Rev. 
med. de la Franche-Comte., 
Besancon, 1907, xv, 17. 

Lee, R. I. and Whittemore, W. — 
The Wassermann reaction in 
syphilis and other diseases — 
Boston M. and S. J., 1909, clx, 
410-412. 

Lefas, L. — Un cas d'eruption syph- 
ilitique sur des cheloides — Pro- 
gres med., Paris, 1906, 3 s. xxii, 
257. 

Lefebore, A. — Les recentes reeherches 
sur la syphilis; transmission, 
immunisation et serotherapie — 
J. med. de Brux., 1906, xi, 209. 

Lefebre, A. — Les faits nouveaux 
dans le domaine de la syphilis — 
Clinique, Brux., 1906, xx, 921. 

Legg, J. B. — A case of congenital 
syphilitic osteo-periostitis of 
the femur of an infant — Med. 
Press and Circ, Lond., 1907, ns. 
lxxxiv, 443. 

Legg, T. P. — Congenital syphilis 
affecting the testicles hydrocele 
of the tunica vaginalis — Poly- 
clin., Lond., 1906, x, 156. 

Legg, T. P. — Multiple gummata of 
the leg — Med. Press and Circ, 
Lond., 1906, ns. lxxxi, 122. 

Legg, T. P. — Multiple gummata of 
the tongue — Med. Press and 
Circ, Lond., 1906, ns. Ixxxii, 
442. 

Legrain, E. — Traumatisme et gomme 
syphilitique — Syphilis, Paris, 

1905, iii, 302. 

Legrand — Syphilis et cancer — Rev. 
prat, d'obst. et de gynec, Paris, 
1908, 371-375. 

Lehmann-iSTitsche — Altpatagonische 
angeblich syphilitische knochen 
aus dem Museum zu La Plata 
—Ztschr. f. Ethnol., Berl., 
1904, xxxvi, 854-962. 

Leiner, C. — Ueber haarausfall bei 
hereditarer lues — Arch. f. Der- 
mat. u. Syph., Wien u. Leipz., 

1906, lxxviii, 239-245. 
Leiner, C. — Ueber haarausfall bei 

hereditarer lues — Verhandl. d. 
Versamml. d. Gesellsch. f. Kin- 
derh. deutsch. Naturf. u. 
Aerzte, 1905, Wiesb., 1906, 261- 
263. 



352 



Recent Bibliography. 



Leiner, C. — Alopecia in hereditary 
syphilis — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1907, xi, 105. 

Leiner, C. — Syphilis extra-genitally 
acquired by children — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1909, xiii, 209-211. 

Lemoine et I audron — Incontinence 
nocturne d'origine hysterique 
chez une adulte syphilitique 
guerison — Bull, et mem. Soc. 
med-chir. du Xord, Lille, 1905. 
tome i, 72. 

Lenglet et Sourdeau — Syphilome 
chancriforme ou chancre de re- 
infection? — Bull. Soc. franc, de 
dermat. et syph.. Paris. 1909. 
xx, 203. 

Lenoble, E. — Valeur semeiologique 
et pronostique de la reaction 
myeloide chez 1<>~ enfants her- 
edo-syphilitiques a gros foie et 
a grosse rate ( syndrome-syph- 
ilitique pseudoleucemiquc ) — 
Compt. rend. Soc. de Biol., 
Pari>. 1905, lviii. 839. 

Lepa, H. — Verblutung ln-i lues nor- 
ida — Allg. med. centr-ztg., 
Berl.. 1909, lxxviii. 133. 

Lespinne — Syphilides ungueales et 
periungueales — Progres med. 
beige. Brux.. 1905. vii. 65. 

Leaser, E. — Syphilisbenandlung im 
lichte der neuen forschungsrp- 
sultate — Deutsche med. 
Wchnschr.. Leipz. u. Berl.. 
1907. xxxiii. 1067. 

Lesser, E. — Die syphilis behand- 
lung im lichte der neuen for- 
schungsresultat — Deutsche 
med. Wchnschr.. Leipz. u. Berl.. 
1907. xxxiii. 1076-1080. 

Lesser. E. — Ein fall von spater post- 
conceptioneller uebertragung 
der svphilis — Berl. klin. Woch., 
1908." xlv, 293-295. 

Lesseh. F. — Tabes und paralyse im 
lichte der neueren syphilis-for- 
schung — Berl. klin. Woch.. 
1908.. xlv. 1762. 

Lesser, F. — Zu welehem schlussen 
berechtigt dis Wassermansche 
reaktion? (serodiagnostik der 
syphilis) — Med. Klin.. Berl., 
190S. iv. 299-302. 

Lesser. F. — Weitere ergebnisse der 
serodiagnostik der syphilis — 
Deutsche med. Woch.. Leipz. u. 
Berl.. 1909. xxxv. 379-383; Dis- 
cussion 417. 



Lesser — Zwei fiille von syphiliti- 
schem exanthem — Berl. klin. 
Woch., 1905, x!ii, 991. 

Lesser, F. — Die serodiagnostik der 
syphilis — Ztschr. f. d. arztl. 
I'rax., 1908, xxi, 234-236. 

Leszcynski, R. — The spirocheta pal- 
lida and diagnosis of syphilis 
— Lwow. tvgodn. lek., 1906, i, 
285, 301. 

Leufestey, J. A. — Infantile syphilis 
— -( 'Unique, Chicago, 1907, 
xxviii. 655-660. 

Leuriaux, C. et Geets, V. — Culture 
de treponema pallidum de 
Schaudinn — Proges med. l>elge, 
Unix.. 1906. viii, 121-123, 1 pi. 

Leuritux. ('. et Geets, V. — Culture 
de treponema pallidum de 
Schaudinn — Centralhl. f. Bak- 
teriol., 1 Abt., Jena, 1906, xli. 
lis (-688. 

Levaditi, C. et Petresco, G. Z.— 
Passage du spirochaete pallida 
dans le liquide de vesicatoire — 
Presse med., Paris, 1905, 617. 

Levaditi — Sur la coloration du spi- 
roehsete pallida Schaudinn dans 
les coupes — ( ompt. rend. Soc. 
de biol., Paris. 1905. lix. 326. 

Leva il i t i — L'histoh >;j ie pa t hologique 
de l'heredo-syphilis dans ses 
rapports avec le spirochaete pal- 
lida Schaudinn — Compt. rend. 
S,„- dp biol., Paris. 1905. lix. 
342. 

Levaditi ''t Sauvage — Sur un cas 
de r, ipliih. hereditiir: tardivs 
avec presence du spirochaete 
pallida dans les visceres — 
< ompt. rend. soc. de biol., 
Paris, 1905. lix, 344. 

Levaditi et Salmon, P. — Localisa- 
tions du spirochete dans un 
fas de syphilis hereditaire — 
Compt. rend soc. de biol. Paris, 
1905, lix, 465. 

Levaditi, C. et Manouelian — His- 
tologic pathologique des acci- 
dents syphilitiques primaires 
et secondaires chez l'homme 
dans ses rapports avec le spi- 
rochaete pallida — Compt. rend, 
soc. de biol.. Paris. 1905, lix, 
527. 

Levaditi, C. et Manouelian— His- 
tologic pathologique du chan- 
cre syphilitique du signe dans 
ses rapports avec le spirochaete 
pallida — Compt. rend. soc. de 
biol., Paris, 1905. lix, 529. 



Recent Bibliography. 



353 



Levaditi, C. — Syphilis congenitale 
et spirochete pallida Schaud- 
inn — Compt. rend. soc. de biol., 
Paris, 1905, Iviii, 845. 

Levaditi, C. and Petresco, G. Z. — 
Spirochete pallida in the exu- 
date of blisters — Tribune med., 
Am. ed., N. Y., 1905, i, 339- 
342. 

Levaditi, C. — Les nouvelles re- 
eherehes sur l'etiologie et la 
pathologie experimentale de la 
syphilis — - Folia haematol., 
Berl., 1906, Hi, 541. 

Levaditi, C. — Bemerkungen zu dem 
aufsatz von W. Schulze (ueber 
silberimpr'agnierung syphilit- 
ischer gewebe zur sichtbarmach- 
ung der spirochete pallida) — 
Berl. kiin. Woch., 1906, xliii, 
1368. 

Levaditi, E. — L'histologie patholo- 
gique de la syphilis hereditaire 
dans ses rapports avec le spiro- 
chete pallida — Ann. d. mal. 
yen., Paris, 1906, i, 22-53. 

Levaditi, C. — L'histologie patholo- 
gique de la syphilis hereditaire 
dans ses rapports avec le spiro- 
chete pallida; — Ann. de l'Inst. 
Pasteur, Paris, 1906, xx, 41-68. 
2 pi. 

Levaditi, C. — Les nouvelles re- 
cherehes sur l'etiologie et la 
pathogenie de la syphilis — Echo 
med. du nord, Lille, 1906, x, 
273, 285. 

Levaditi et Manouelian — Nouvelle 
methode rapide pour la colora- 
tion des spirochetes sur coupes 
— 'Compt. rend. soc. de biol., 
Paris, 1906, lx, 134-136. 

Levaditi, C. — Morphologie et cul- 
ture du spirochete refringens 
( Sehaudinn et Hoffmann ) — 
Compt. rend. soc. de biol., 
Paris, 1906, lxi, 182-184. 

Levaditi, C. — Transmission de la 
balano-posthite erosive circinee 
au chirnpanze; role du spiro- 
chete refringens — Compt. rend, 
soc. de biol., Paris, 1906, lxi, 
184-186. 

Levaditi, C. et Yamanouchi, T. — Le 
sero-diagnostic de la syphilis — 
Compt. rend. soc. de biol., Paris, 
1907, lxiii, 740-742. 

Levaditi, C- — La question de la 
syphilis au xiv Congres d'hy- 
giene et demographie — Presse 
med., Paris, 1907, xv, 721-724. 



Levaditi, C. — Le sero-reaction de la 
syphilis — Presse med., Paris, 
1907, xv, 321. 

Levaditi, C. et Mcintosh, J. — Con- 
tribution a l'etude de la cul- 
ture de treponema pallidum — 
Ann. de l'Inst. Pasteur, Paris, 

1907, xxi, 784-797, 2 pi. 
Levaditi, C. et Yamanouchi, T. — 

Recherches sur l'incubation 
dans la syphilis — Compt. rend, 
soc. de biol., Paris, 1908, lxiv, 
• 50-52. 

Levaditi, C. et Yamanouchi, T. — 
Recidive de la keratite syph- 
ilitique du lapin; mode de di- 
vision du trepenome — Compt. 
rend. soc. de biol., Paris, 1908, 
lxiv, 408-410. 

Levaditi, C. Laroche et Yamanouchi 
— Le diagnostic precoce de la 
syphilis par la methode de Was- 
sermann — Compt. rend. Soc. de 
biol., Paris, 1908, lxiv, 720-722. 

Levaditi, C. et Yamanouchi, T. — 
Inoculation de la syphilis au 
preface du lapin — Compt. rend, 
soc. de biol., Paris, 1908, lxiv, 
957-959. 

Levaditi, C. et Yamanouchi, T. — La 
transmission de la syphilis au 
chat — Compt. rend. Acad. d. 
sc, Paris, cxlvi, 1120-1122. 

Levaditi, C. — Les nouveaux moyens 
de diagnostic microbiologique 
et serologique de la syphilis — 
Ann. de dermat. et syph., Paris, 
1909, 4s. x, 119-130, 187, 259. 

Levaditi, C. — Le serodiagnostie de 
la syphilis — Clin, opht., Paris, 
190S, xiv, 73-76. 

Levaditi, C. et Nattan-Larrier, L. — 
Contribution a l'etude micro- 
biologique et experimentale du 
pian — Ann. de l'inst. Pasteur, 
Paris, 1908, xxii, 260-270. 

Levaditi, C. — Le sero-diagnostic de 
la syphilis — Clin. prat. mal. d. 
yeux du larynx, Paris, 1908, iv, 
213-222. 

Levaditi, C. — Le serodiagnostie de 
la syphilis — Clinique Brux., 

1908, xxii, 245-259. 
Levaditi et Nattan-Larrier — A pro- 

pos de la note de M. Ch. Nico- 
las sur le pian — Bull. Soc. path, 
exot., Paris, 1908, i, 487-489. 
Levi — Due parole a proposito della 
spirochete pallida — Gior. ital, 
d. mal. ven., Milano, 1906, xli, 
532. 



354 



Recent Bibliography. 



Levin, I. — Synovitis of the knee- 
joint as a late manifestation of 
acquired syphilis; report of a 
case— Med. Rec. N\ Y., 1908, 
lxxiv, 836-838. 

Levy-Bing, A. — Des moyens de col- 
oration du spirochete pallida — 
Syphilis Paris. 1905. iii. 675- 
684. 

Levy-Bing. A. — Des moyens de col- 
oration du spirochete pallida — 
Bull, med., Paris, 1905, xix, 
572. 

Levy-Bing. A. — Recherche du spiro- 
chete pallida dans le sang des 
syphilitiques — Bull. med., 
Paris, 1905, xix, 604. 

Levy-Bing. A. — Le micro-nrganisine 
do la syphilis treponema palli- 
dum (Sehaudinn) — Clinique. 
Paris, 1908, iii, 200-214. 

Levy Bin?:. A. — Des differentes 
methodes nour eolorer ics pio- 
tozoaires .'t .-n particul ir hi 
spirochete pallida — Ann. d. 
mal. ven. Paris, 1909. iv, 181- 
188. 

Levy-Franckel, A. — Osceo-peri »Rti'e 
suppuree de l'lieredo-syphilis 
tertiaire — Ann. d. mal. ven., 
Paris, 1906, i, 122. 

Levy-Franckel. A. — Des nephrites 
syphilitiques aecondaires tar- 
dives — Ann. il. mal. ven.. Paris, 
1907. ii. 685-693. 

Levy-Franckel, A. — Lesions de 
l'aorte ehez les heredo-syphilit- 
iques nouveaux-nes — Compt. 
rend. soc. de biol.. Paris, 1909. 
Ixvi. 731. 

Levy-Franckel, A. — Les aortites 
aigues et ehroniques et l'ath- 
erome dans la syphilis heredi- 
taire — Ann. d. mal. ven., Paris. 
1909. iv. 732-773. 

Liherman. Va Yu — Investigation of 
the spirocheta pallida when 
alive — Russk. Yraeh.. S. 
Petersb., 1908, vi, 810-812. 

Lichtmann — Spirochete pallida im 
lichte siphiliticus ■ — Dermat. 
Central., Leipz., 1907, xi, 5-10. 

Lichtmann. .T. — Zur syphilis-diag- 
nose — St. Petersb. med. Woch., 
1909. xxxiv, 107-110. 

Liebermann. J. M. — Further re- 
search on syphilis; by what 
data, sign or symptom can we 
determine a cure? — N. York 
State J. M., X. Y., 1906. vi. 
288-291. 



Uefmann. H. — Ueber den mechan- 
ismus der seroreaktion der lues 
— Centralbl. f. Bakteriol., 1 
Abt., Jena, 1909, xliv, 42-45. 

Lietnik— Case of galloping syphilis 
— Russk. j. kozhn. i. ven. 
boliezn., Kharkov, 1905, x, 230- 
232. 

Liffran — Diagnostic microscopique 
de la syphilis; notes sur la 
technique — Area, de med. nav , 
Paris, 1909, \ci. 388-390. 

Lindenberger, L. — Spirochseta of 
Sehaudinn and syphilis — Ken- 
tuckv M. J., Bowling Green, 
1907-S. v. No. 8, 30-32. 

Lippmann. H. — Ueber den zusam- 
menhang von idiotie und syph- 
ilis — Miinchen med. Woch., 
1909, lvi. 2418. 

Lippolis, V. — Sopra un caso di 
sifiloderma polimorfo (roseola 
tardiva sifilodema areolare pig- 
mentato sifiloderma tuberco- 
Iaire) — Gazz. internaz. di med., 
Napoli, 1909, xii., 26-28. 

Lipschutz, B. — Zur kenntnis der 
spirochete pallida im syphil- 
itischen gewebe — Wien klin. 
Woch., 1906. xix. 1110-1114. 

Lipschutz, B. — Ueber die beziehun- 
gen der spirocheta pallida zum 
hautpigment syphilitischer ef- 
foreszenzen — Dermat. Ztschr., 
Berl.. 1907, xiv, 67-88. 

Lipschutz. B. — Untersuchung ueber 
die spirochete pallida Sehaud- 
inn — Deutsche mod. Woch., 
Leipz. u. Berl.. 1905, xxxi, 1832. 

De Lisle. J. — Nouvelles recherehes 
^ur le microbe de la syphilis — 
Arch. gen. de med., Paris, 1905, 
ii. 2945. 

De Lisle. J. — A simplified method 
for the isolation of the bacillus 
of syphilis — Am. J. Dermat. 
and Genito-Urin. Dis., St. Louis. 
1908. xii, 118-121. 

Litterer. W. — Some observations on 
the serum diagnosis of syphilis 
— J. South. M. Ass.. Shreve- 
port, 1909. vi. 343-357. 

Litterer. W. — Sero-diagnosis of 
svphilis — I. Am. M. Ass., Chi- 
cago. 1909. liii. 1537-1541. 

Little, E. G. G. — Case of tertiary 
syphilis of unusually extensive 
distribution — Proc. Roy. Soc. 
Med., Lond., 1908-9, ii, Dermat. 
Sect. 9. 



Recent Bibliography. 



355 



Little, G. — Case of framboesiform 
syphilis — Brit. J. Dermat., 
Lond., 1905, xvii, 108. 

Little, E. G. G. — Case of acquired 
syphilis in a female child aged 
four — Proc. Rey. Soc. Med., 
Lond., 1908-9, ii ; Dermat. Sect. 
87. 

Loew, L. — Ein seltener fall von 
leukoderma syphiliticum — Arch, 
f. Dermat. u. Syph., Wien u. 
Leiuz., 1906, Ixxxii, 241. 

Loew, L. — Leukoderma syphiliticum 
— Ritka esete Badapesti orv 
ujsag, 1906, iv, 615. 

Loewenthal, M. — Das kausalverhalt- 
niss zwischen syphilis und pro- 
gressivem nervenschwund — 
Neurol. Centralbl., Leipz, 1907, 
xxvi, 434-445. 

Loewenthal, W. — Beitrag zur kennt- 
nis der spirochaeten — Berl. klin. 
Wchnschr., 1906, xliii, 283-285. 

Logan, W. H. G. — General consid- 
eration of syphilis, with special 
reference to differential diag- 
nosis between syphilitic and 
non-syphilitic lesions as mani- 
fested in mouth — Dental Rev., 
'Chicago, 1908, xxii, 799-813; 
Discussion 852-859. 

Lombard, A. — Ce qu'on pensait au- 
trefois de la graine — Chron. 
med., Paris, 1905, xii, 431. 

Lomovitski, P. F. — Primary sclero- 
sis of the uper lip — Russk, j. 
kozhn. i. ven. boliezn, Kharkov, 
1905, x, 30. 

Loneier, M. — Ueber riesenzelbildung 
der leber bei lues congenita — 
Beitr. z. path. anat. u. z. allg. 
Path., Jena, 1906, xxxix, 539- 
562. 

Long, J. P. — -The Wassermann re- 
action for the serum diagnosis 
of syphilis, with report of four 
cases — Alabama M. J., Bir- 
mingh., 1908-9, xxi, 485-489. 

Lopez, G. — Contribucion al estudio 
dio de los trastornos mentales 
de los sifiliticos — Rev. de med. 
y cirurg. de la Habana, 1905, 
x, 599-605. 

Lopez, G. — Caquexia sifllitica frac- 
tures; multiples expontaneas — 
Gac. san. de Barcel., 1907, xix, 
1. 

Lortat, Jacob L. — Valeur diag- 
nostique de la seiatique radicu- 
laire (le syndrome radiculaire 
seiatique et la syphilis) — Trib- 



une med., Paris, 1906, ns. 
xxxviii, 181. 

Lortet, L. — Crane syphilitique de la 
necropole prehistorique de Roda 
( Haute-Egypte ) — Lyon med., 
1907, cix, 539-541. 

Lortet, L. — Crane prehistorique 
syphilitique — Compt. rend. 
Acad. d. sc, Paris, 1907, cxlv, 
25-27. 

Lortet, L. — Crane syphilitique de la 
necropole prehistorique de Roda 
(Haute-Egypte) — Bull. Soc. 
med. d. hop. de Lyon, 1907, vi, 
256-259. 

Lortet, L. — Une exostose syphilit- 
ique d'un crane prehistorique — 
Lyon, med., 1907, cix, 141. 

Lowenburg, H. — Syphilitic fever ; 
report of a ease — Med. Bull., 
Phila., 1906, xxxv, 173-178. 

Lowy, K. — Beitrage zur spiro- 
chsetenfrage — Arch. f. Dermat. 
u. Syph., Wien u. Leipz., 1906, 
lxxxi, 107-126. 

Loxton, A. — Some remarks upon the 
spirocheta pallida and the 
early diagnosis of syphilis — 
Midland M. J., Birmingh., 
1906, v, 178. 

Loygue, G. — Infection syphilitique 
ou intoxication mercurielle? — 
Presse med., Paris, 1909, xvii, 
270. 

Loze, Leredde, et Martial, R. — Myo- 
site syphilitique gommeuse du 
biceps — Rev. prat. d. mal cu- 
tan., Paris, 1907, xxxvi, 235- 
242. 

De Luca, R. e Casagrandi, O. — Ten- 
tativi di profilassi e di terapia 
antisifilitica, con filtrati ami- 
crobiei di manifestazioni sifi- 
litiehe e con siero di ne trat 
tato con i filtrati stessi — Gior. 
ital. d. mal ven. Milano, 1905, 
xl, 661-679. 

De Luca, R. e Casgrandi, 0. — Su di 
un nuovo reperto batteriologico 
osserato con costanza in aleuni 
sifilomi prima ri uleerati bac- 
terium syphilomatis ulcerosi— 
Gior. ital. d. mal. ven., Milano, 
1906. xli, 71-92. 

Lucas, R. C. — A healthy child 
showing no signs of syphilis 
suckled by a mother inoculated 
with syphilis subsequent to the 
birth of her child — Brit. J. 
Child. Dis., Lond., 1908, v, 10- 
13. 



356 



Recent Bibliography. 



Lucas, R. C. — Inherited syphilis- 
lied. Press and Circ, Lond., 

1908, ns. lxxxv, 8-11. 
Lucas, R. C. — An address on in- 
herited syphilis — Brit. M. J., 

Lond., 1907, 1, 250-252. 
Lucas, R. C. — Sifilide ereditata — 

Salute pubb., Perugia, 1908, 

xxi, 30-35. 
Lucas, R. C. — Inherited syphilis — 

Brit. J. Child. Dis., Lond., 1908, 

y, 1-10. 
Lucas, R. C. — Inherited syphilis — 

Rep. Soc. Study Dis. Child., 

Lond., 1908, viii, 62-74. 
Lukin, F. — Non-sexual infection 

with syphilis — Med. pribav. k. 

morsk. sborniku., St. Petersb., 

1905, 222. 
Luna, Z. — El chancro fagedenico es 

comunmente sifilitieo — Cron. 

med. mexicana, Mexico, 1906, 

ix, 141-151. 
Luna. Z. — El chancro fagedenico es 

comunmente sifilitieo — Cron. 

med. mexicana, Mexico, 1906, 

ix, 225-229. 
Lustgarten — Syphilitic affection of 

the upper lip — J. Cutan. Dis. 

incl. Syph., X. Y., 1907, xxy, 

306-309. 
Lydston, G. F. — Syphilis hereditaria 

tarda— Pediatrics, N Y. ; 1907, 

xix. 585-595. 



M 

Maas. J. F. — Ernstige syphilis met 
gunstigen inyloed op een voor- 
afgaande keratosis palmaris et 
plantaris — Med. YVeekbl., 
Amst.. 1907-8, xiy. 257. 

McCrory, M. — The control of syph- 
ilis — Med. Age, Detroit, 1905, 
xxiii, 850-858. 

McDonagh, J. E. R. — The method 
of demonstrating the spirochaeta 
pallida by the blackground il- 
lumination — Brit. J. Dermat., 
Lond., 1909, xxi, 290-292. 

McDonagh, J. E., Muller, R. and 
Morawetz, G. — The serum diag- 
nosis of syphilis, Practitioner, 
Lond., 1909, lxxxiii, 307-326. 

McGowan. G. — The moral aspects of 
syphilis — Calif. M. and S. Re- 
porter, Los Angeles, 1905, i, 
282. 



Mcintosh, J. — The occurrance and 
distribution of the spirochaeta 
pallida in congenital syphilis — 
J. Path, and Bacteriol.. Cam- 
bridge, 1908-9, xiii, 239-247, 2 

Pi. 

Mcintosh, J. — The distribution of 
the spirochaeta pertenuis in the 
lesions of experimental yaws — 
J. Path, and Bacteriology. Cam- 
bridge, 190S-9, xiii, 248-250. 

Mcintosh, J. — The sero-diagnosis of 
syphilis — Lancet, Lond., 1909, i, 
1515-1521. 

Mcintosh, J. — On the presence of the 
spirochaeta pallida (Treponema 
pallidum) in the oya of a con- 
genital syphilitic child — Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena, 1909, li, Orig., 11-13. 

Mcintosh, W. P. — Syphilis — Am. 
Med., Burlington, ' Vt. and N. 
Y., 1908, ns. ill, 153, 201, 263. 

McKee, H. — A mucous patch on 
the conjunctiva, with demonstra- 
tion of the spirochaete pallida. — 
Ophth. Rec, Chicago, 1909, 
xviii, 63. 

McKenna, J. A. — Syphilitic fever — 
Med. Xews, X. Y., 1905, lxxxvii, 
1126. 

McKenzie, Ivy — The serum diagnosis 
of syphilis — J. Path, and Bac- 
teriol., Cambridge, 1908-9, xiii, 
311-324. 

McMm-ty, C. \Y.— The use of a 
printed chart in the serum di- 
agnosis of syphilis — X. York 
M. J., 1909, Ixxxix, 954. 

McXaughton, J. G. — A case of syph- 
ilis following the bite of a hu- 
man being — Lancet, Lond., 
1906, i, 29. 

McWeeny, E. J. — Spirochaetae in 
syphilis — Brit. M. J., Lond., 
1905, i, 1262. 

MacDonald, W. G. — The prophylaxis 
of syphilis — Bost. M. and S. J., 

1905, clii, 100. 

MacKee, G. M. — The diagnostic 
value of the spirochaeta pallida 
in syphilis — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 

1906. x, 145-150. 

MacKee, G. M. — The spirochaeta pal- 
lida in syphilis, with special 
reference to Goldhorn's rapid 
staining method — X. York M. 
J., 1906, lxxxiii, 588-592. 



Recent Bibliography. 



357 



MacKee, G. M. — A report of four 
luetic cases unassociated with 
observable secondary manifesta- 
tions— Med. Bee., N. Y., 1907, 
Ixxxi, 563. 

Mackenzie, W. — A case of general- 
ized subcutaneous emphysema 
the result of miliary tubercu- 
losis in a syphilitic child — 
Arch. Pediat., 1906, xxiii, 527- 
529. 

MacLennan, A. — A preliminary note 
upon the cytorrhyctes luis 
(Siegel) and the spirochfeta 
pallida — Brit. M. J., Lond., 
1906, i, 258. 

MacLennan, A. — On the spirochaeta 
pallida and its variations — 
Brit. M. J., Lond., 1906, 1090. 

MacLennan, A. — Specimen of the 
spirochaeta pallida, with re- 
marks on the method of stain- 
ing — Glasgow M. J., 1906, lxv, 
201-209. 

MacLennan, A. — Demonstration of 
spirochetes from syphilis, yaws 
and granuloma pudendi, with 
remarks upon the protoplasmic 
bodies in syphilitic material — 
Glasgow M. J., 1907, lxvii, 148. 

MacLennan, A. — The place of of the 
spirochaeta pallida in the diag- 
nosis of syphilis — Brit. M. J., 
Lond., 1907, ii, 1510. 

MacNeal, W. J. — A rapid and sim- 
ple method of staining spiro- 
chaeta pallida — J. Am. M. Ass., 
Chicago, 1907, xlviii, 609. 

MacNeal, W. J. — A rapid method of 
staining spirochaeta pallida — 
West Virg. M. J., Wheeling, 
1907-8, ii, 150. 

MacNider — Some of the later mani- 
festations of syphilis, with re- 
port of cases — Charlotte, N. C. 
M. J., 1907, xxxi, 125-127. 

MacWhinnie, A. M. — Present status 
of the spirochaeta pallida — 
Northwest. Med., .Seattle, 1909, 
vii, 221-223. 

Macry, N. — Darf der arzt der vom 
ehemanne mit lues infizierten 
frau die natur ihre leidens ver- 
schweigen? — Deutsche med. 
Wchsnchr., Leipz. u. Berl., 1908, 
xxxiv, 2127. 

Magian, A. C. — A case of syphilis 
without a primary chancre; 
syphilis d'emblee followed un- 



der two years by re-infection — 
Brit. M. J., Lond., 1909, ii, 652- 
653. 

I, M. 0.— Congenital pyloric 
obstruction in an infant — Am. 
Med., Burlington, Vt. and N. 
Y., 1909, ns. iv, 155-157. 

Magne, P. — Syphilis maligne pre- 
coce terminee par une meningite 
aigue — Gaz. hebd. d. sc. med. de 
Bordeaux, 1907, xxviii, 493-495. 

Malherbe, H. — La sarcocele syph- 
ilitique — Gaz. med. de Nantes, 
1907, 2 s. xxv, 701-711. 

Malherbe, H. — Ulceration de Vin- 
cent et chancre syphilitique dif- 
ficulte du diagnostic — Gaz. med. 
de Nantes, 1905, 2 s. xxiii, 977. 

Malherbe, H. — Sur le debut des 
chancres syphilitiques genitaux; 
cas de diagnostic — Gaz. med. de 
Nantes, 1906, 2 s. xxiv, 973-986. 

Malherbe, H. — Les syphilis ignorees 
— Gaz. med. de Nantes, 1908, 
2s. xxvi, 931-939. 

Malherbe, H. — Le sarcocele syphilit- 
ique — J. d. mal. cutan. et syph., 
Paris, 1908, xix, 198-206. 

Malherbe, H. — Les syphilis ignorees 
— J. d. mal. cutan, et syph., 
Paris, 1908, xix, 881-888. 

Malinowski, F. — Spirochete pallida 
bei tertiarer syphilis — Monatsh. 
f. prakt. Dermat., Hamb., 1907, 
xlv, 499. 

Malinowski, F. — Spirochete pallida 
in tertiary syphilis — Przegl. 
chorob. skor. i. wen., Warszawa, 
1907, ii, 58. 

Malinowski, F. — Pathological inves- 
tigations of syphilitic changes 
in the skin and mucosae — 
Prezgl. chorob. skor. i. wen., 
Warszawa, 1908, iii, 113, 223. 

Malinowski, F. — Importance of Was- 
sermann's reaction in syphilis — 
Przegl. chorob. skor. i. wen., 
Warszawa, 1909, iv, 1-13. 

Manahan, T. J. — A demonstration of 
the spirochaeta pallida of syph- 
ilis, with description of rapid 
method of staining — Boston M. 
and S. J., 1906, cliv, 264-266, 
lpl. 

Manahan, T. J. — A demonstration 
with description of rapid 
method staining — Mass. Gen. 
Hosp., Bost., 1907, No. 3, i, 
193-202. 



358 



Recent Bibliography. 



Maneini, A. — Un caso raro di rein- 
fezione sifilitica — Gior. med. d. 
r. esercito, Roma, 1907. lv, 770- 
773. 

Mandelbauna, M. — Eine vitale far- 
bung der spirochete pallida — 
Miinchen med. Woeh.. 1907, liv, 
2268. 

Mann, C. — A ease for diagnosis — 
Am. J. Dermat and Genito- 
Urin. Dis., St. Louis, 1908, xii. 
473. 

Mannaberg, J. — LTeber iutermitten- 
tierendes fieber bei viszeraler 
syphilis, namentlich bei leber- 
svphilis — Ztsehr. f. klin. med., 
Berl.. 1907, lxii, 253-261. 

Mantegazza. U. — Ultime ricerehe 
sulla eziologia e transmissione 
sperinientale della sifilide — 
Gior. ital. d. nial. mil. Milano, 
1906, xli, 129-1.50. 

Mantegazza, U. — Sifilide e matri 
monio — i brriere san., Milano, 

1908, xix, 243, 265. 
Mantegazza, U. — Epedemie famigli- 

ari da sifilide d'allattamento — 
Corriere san., Milano. 190S. xix, 
708, -'12. 

Manwaring, W. H. — Ueber die be- 
ziehungen von enzyniwirkungen 
zu den erscheinungen deT soge- 
nannten komplementablenkung 
bei syphilis — Ztsehr. f. immun- 
itfitsforsch. u. exper. therap., 
Jena, L909, iii, 309-337. 

Marchsi, C. — Sifiloderme pigmenta- 
rio — Gazz. internaz. di med., 
Napolio, 1908, xi, 105-107. 

Marchildron, J. W. — The theory, 
technic and practical results of 
the reaction for the serum di- 
agnosis of syphilis — St. Loui.-> 
M. Rev., I'M is. Mi, 376-380. 

Marchildon, J. W. — A comparison 
of alcoholic and watery ex- 
tracts in the serum diagnosis 
of syphilis — J. Am. M. Ass., 
Chicago, 1908, ii. 2149-2151. 

Marchildon. J. W. — Some results 
with tin' Wassermann reaction 
for the serum diagnosis of 
svpbilis — St. Louis M. Rev., 

1909, iii, 321-323. 
Marchildon, J. W. — Sofe results 

with the Wassermann reaction 
for the serum diagnosis oi 
syphilis — J. Missouri M. Ass., 
St. Louis, 1909-10, vi, 321-325. 



Marcou, G. — Syphilis et vitiligo— 
Rev. internat. de med. et de 
chir., Paris, 1906, xvii, 162-166. 

Marcou. G. — Facteurs de gravite de 
la syphilis, les doctrines de la 
graine et du terrain la syphilis 
exotique ou colonials! — Rev. in- 
ternat. de med. et chir., Paris, 
1907. xviii, 101. 

Marcus, K. — Ein fall von venen- 
syphilis in sekundarstadium — 
Arch. f. Dermat. u. Syph., 
VVien u. Leipz., 1905, lxxvii, 43- 
54, 3 1>1. 

Marcus, K. — Om serumdiagnosen af 
syphilis ( Wasserma tin's reak- 
tion) — Hvgeia, Stockholm, 
1909, 2 f. ix, 216-232. 

Marfan, A. B. — Coinage congenitale 
chronique hypertrophic du thy- 
mus -ypliilis hereditaire — Syph- 
ilis, Paris, 1905. iii, 285-301. 

Marfan. A. 15. — Cornage congenitale 
chronique hypertrophic du thy- 
mus syphilis hereditaire — Arch, 
internat. de laryngol., Paris, 

1905. xix, 372-384. 

Marfan. A. B. — Suppurations artic- 
ulaires et extra articulaires 
dans la pseudo-paralysie des 
nouveau-nes syphilitiques — 
Rev. mens d. mal de l'enf., 
Paris. 1906. xxiv. 193-205, 1 pi. 

Marfan et Weill-Halle, B.— Sarco- 
cele heredo-syphilitique avec 
keratite parenehymateuse chez 
un enfant de 6 ans % — Bull. 
Soc. de pediat. de Paris, 1907, 
ix. 2(19 212. 

Marfan et Weill-Halle. B. — Sarco- 
eele heredo-syphilitique avec 
keratite parenehymateuse chez 
enfant de six ans et demi— 
Rev. prat, d'obst. et de pediat., 
Paris, 1907. xx, 299-302. 

Marfanet Weill-Halle, B. — Sarco- 
cele heredo-syphilitique avec 
keratite parenehymateuse chez 
un enfant de 6 ans l /» — Ann. de 
med. et chir. inf., Paris, 1907, 
xi, 579-581. 

Markley. A. J. — Some atypical 
cases of syphilis; a clinical 
studv — Lancet-Clinic, Cincin., 

1906, ns. lvii, 277-279. 
Markoff, N. X. — Rare case of non- 
sexual syphilitic infection — 
Russk. j. kozhn. i. ven. boliezn., 
Kharkov, 1905, x, 32. 



Recent Bibliography. 



359 



Marschik, H. — Das klein gummose 
syphilid des raehens — Wien 
klin. Woch., 1908, xxi, 565-568. 

Marsh, H. M. — Secondary syphilis — 
N. Albany M. Herald, 1905-6, 
xxiv, 173. 

Marshall, C. F. — Syphilis of the 
third generation — Lancet, 
Lond., ii, 591. 

Marshall, C. F. — The triad of 
Hutchinson — Treatment, Lond., 
1905-6, ix, 401-410. 

Marshall, C. F. — Recent research in 
the bacteriology of syphilis and 
in experimental syphilology — 
Treatment, Lond., 1905-6, ix, 
481-491. 

Marshall, C. E. — Transmission of 
syphilis to the third generation 
— Treatment, Lond., 1905-6 ix, 
721. 

Marshall, C. F. — The syphilitic ori- 
gin of leucoplasia — Treatment, 
Lond., 1905-6, ix, 815. 

Marshall, C. F. — The transmission 
of syphilis to the second gen- 
eration — Brit. M. J., Lond., 
1908, i, 782. 

Martial, R. — L'etat actuel des re- 
cherches sur la syphilis experi- 
mentelle d'apres Prof. A. Neis- 
ser — Rev. prat. d. mal cutan., 
Paris, 1907, vi, 179, 188, 209, 
222. 

Martial, R. — Les localisations sys- 
tematiques du treponema palli- 
dum — Clinique, Paris, 1908, iii, 
540. 

Martin, C. — Syphilis in its relation 
to the oral cavity — Dental 
Brief, Phila., 1908, xiii, 748- 
753. 

Martin, Salazar M. — El spirochete 
pallida como causa de la sifilis 
— Rev. de san. mil., Madrid, 
1906, xx, 5, 36. 

Martin, Salazar M. — El suero-diag- 
nostico de la sifilis — Rev. de 
san. mil., Madrid, 1906, xx, 
269-274. 

Martinet, A. — Le calendrier du 
syphilitique — Presse med., 
Paris, 1906, xiv, 403. 

Martisinovski, E. I. — Spirochete 
pallida in sifilis— Med. Obozr., 
Mosk., 1906, lxv, 584-592, 1 pi. 

Marzacchi, V. e Garra, E. — Sulla 
spirochetal pallida— Gior. ital. 
d. mal. ven., Milano, 1905, xl, 
648-660. 



Maslakowetz, P. P. u. Liebermann, 
J. J. — Theorie und technik der 
reaktion von Wassermann und 
die diagnostische bedeutung 
derselben — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1908, xlvii, 
Orig. 379-393. 

Mason, R. D. — Syphilis in abdomi- 
nal and rectal surgery — Am. J. 
Clin. Med., Chicago, 1907, xiv, 
51. 

Massabuau — L'orchite syphilitique 
a debut innammatoires ses le- 
sions histologiques — Montpel. 
med., 1908, xxvii, 9-15. 

Massardo, Maria Fernanda — Sifilide 
recente panadenopatia roseola 
papule nei genitalia ipercromia 
congenita verruche pigmentose 
faringite catarrale — Clin, der- 
mosifilopat. d. r. Univ. di Roma, 
1905. xxiii, 106. 

Mathieu — Syphilis et tuberculose — 
Bull, de laryngol. otol. et rhi- 
nol., Paris, 1908, xi, 174-178. 

Matson, R. C. — The complement de- 
viation test in syphilis — -North- 
west, med., Seattle, 1909-10, ns. 
i, 13-19, 4 pi: 

Matzenauer, R. — Syphilis and hered- 
ity — Srpski. arh. za celok. lek, 
Beograd, 1905, xi, 173. 

Matzenauer, R.— Grenzgebiete der 
dermatologie und syphilis — 
Wien klin. Woch., 1907, xx, 
H40-1442. 

Mauclaire — Symptomes diagnostic 
et traitement de la syphilis os- 
seuse hereditaire ou acquise — 
Rev. gen. de clin. et de therap., 
Paris, 1905, xix, 545. 

Mauriac, P. — La sero-reaction de 
Wassermann statistiques — 
Compt. rend. soc. de biol., 
Paris, 1909, lxvi, 666. 

Mauric, P. — Conclusions fournies 
par trois cents cas de sero- 
reaction de Wassermann— 
Compt. rend. soc. de biol., 
Paris, 1909, lxvi, 668-670. 

Mauriae, P. — La sero-rea-etion de 
Wassermann peut-elle controler 
le traitement et la guerison de 
la, syphilis ? — J. de med. de Bor- 
deaux, 1909, xxxix, 489-491. 

Mayasima — Ueber spirochete der 
syphilis. (Ausz. Hft. 24) 
(Japanese text) — Mitt. d. med. 
Gessellsch. zu. Tokyo, 1905, 
xix, 1078-1090. 



360 



Recent Bibliography. 



Mayer, E. E. and Proescher, F. — 
The serum diagnosis of syph- 
ilitic diseases — Arch. Int. Med., 
Chicago, 1908, ii, 55-61. 

Mayer, M. — Spirochaetenbefunde bei 
f ramboesia tropica — Deutsche 
med. Woch., Leipz. u. Berl., 

1907, xxxiii, 462. 

Mazzeo, P.- — Contribute alia trans- 
missione alternate del'eredo- 
sifilide — Pediatria, Xapoli, 

1908, 2 s. vi, 102-118. 
Mazzini, F. — Contribuzione alio stu- 
dio del sifiloma extra-genitale 
— Gazz. internaz. d. med. Xa- 
poli, 1908, xi, 282. 

Mazzolani. A. — La sifilide congenita 
dei poppanti nei suoi rapporti 
coll' allattamento mercenario e 
colla tuetela della salute pubb- 
lica — Rassegna san. di Roma, 
1906, iv, 254, 265, 274. 

Meachen, G. X. — Tertiary syphilis 
having a resemblance to rosacea 
— West Lond. M. .!., Lond., 

1906, xi, 136. 

Meachen. G. X. — Quinine dermatitis 
with tertiary syphilis — -Med. 
Times and Hosp. Gaz., Lond., 

1907, xxxv. 72. 

Mebeau, .1. — A propos de la micro- 
biologic de la syphilis — J. d. 
mal. cutan. et syph., Paris, 

1908, xix, 801-836." 

Meier. G. — Die technik zuverlassig- 
keit und klinische bedeutung 
der Wassermannschen reaktion 
auf syphilis — Berl. klin. Woch., 
1907,'xliv. 1636-1642. 

Meirowsky, E. — Die Schurmannsche 
methode des luesnachweises 
mittelst farbenreaktion — 

Deutsche med Woch., Leipz. u. 
Berl.. 1909, xxxv, 937. 

Meierowsky, E. — TJeber die von 
Bauer vorgeschlagene technik 
der Wassermann-A. Xeisser- 
Bruckschen reaktion — Berl. 
klin. Woch., 1909, xlvi, 152-154. 

Meirowsky, E. — Ueber die von M. 
Stern vorgeschlagene modifika- 
tion der Wassermann-A. Xeis- 
ser-Bruckschen reaktion — Berl. 
klin. Woch., 1909, xlvi, 1310- 
1312. 

Melvin, G. G. — Disputed points in 
syphilis — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1905, ix, 1-6. 



Memelsdorf, A. — Spirochete pallida 
— Illinois M. Bull., Chicago, 
1905-6, vi, 581. 

Memelsdorf, A. — Spirochete pallida 
— X. York med. Monatschr., 
1906, xviii, 265. 

Menard, V., Le Moine, F. et Penard, 
I. — -Contribution a l'etude clin- 
ique et radiographique de la 
syphilis hereditaire des os longs 
— Gaz. d. hop., Paris, 1908, 
lxxxi, 567-574, 603. 

Mendes, da Costa — Spirochsete pal- 
lida bij syphilis — Xederl., Tijd- 
schr. v. Geneesk., Amst., 1906, 
2. r. d. i, 181-184. 

Mendes,, da Costa — Enkele gwallen 
van herpetiforme syphiliden — 
Med. Weekbl., Amst., 1908, xiv, 
497-501. 

Menetrier, P. et Rubens, Duval H. — 
Sur un cas de septicemie a 
spirochete de Schaudinn chez 
un nouveau-ne syphilitique — 
Bull, et mem. Soc. med. d. hop. 
de Paris, 1905, 3 s. xxii, 1059- 
1063. 

La Mensa, X. — Sulle gomme autoc- 
tone sifilitiche defl'uretra (sifi- 
lomi cilindroide di Fournier) — 
Follia urolog., Leipz. 1908, ii, 
186-193. 

Mense, C. — Ueber einen lange zeit 
verkannten und ale tuberku- 
lose mittelmeerfieber und ma- 
laria behandelten fall von sp&t- 
syphilitischem fieber — Beihftc 
z. Aech. f. Schiffs-u. Tropenhvg., 
Leipz., 1908, Hft. 5, 99-103. 

De Meric, H. — Extensive syphilitic 
condylomata — Med. Press and 
Circ.', Lond., 1906, lxxxi, 500. 

Merk, L. — Ceber den cytoryktes 
luis (Siegel) — Wien klin. 
Woch., 1905, xviii. 926. 

Merk, L. — Klinisches und kausisti- 
sches von den syphilitischen er- 
scheinungen an den schlaga- 
dern der extremitaten— Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz., 1907, lxxxiv, 435-444, 
1 pi. 

Merklen. P. — Heredo-svphilis lin- 
guale precoce — Ann. de dermat. 
et syph., Paris, 4 s. ix, 106-108. 

Merle. P. — Chancre de la conjunc- 
tive — Ann. d. mal. ven., Paris, 
1909, iv, 267-271. 

Mery — La triade d'Hutchison — Rev. 
internat. de med. et de chir., 
Paris, 1905, xvi, 58. 



Recent Bibliography. 



361 



Mery et Terrien, E. — Un cas de 
syphilis pharyngee et pulmon- 
aire ayant simule de tous points 
la tuberculose — Bull. Soc. de 
pediat., Paris, 1905, vii, 223. 

Mery, H. et Armand-Delille, P. — 
Glossite sclero-gommeuse d'or- 
igine heredo-syphilitiaue chez 
un garcon de 9 ans — Bull. Soc. 
de pediat., Paris, 1906, viii, 
405. 

Mery et Delisle, A. — Syphilis her- 
editaire tardive ulcerations de 
la gorge — Gaz. d. mal. infant, 
Paris, 1907, ix, 5. 

Merzbacher, L. — Die beziehung der 
syphilis zur lymphocytose der 
cerebrospinalfliissigkeit und zur 
lehre von der meningitischen 
reizung — Centralbl. f. Nervenh. 
u. Psychiat., Berl. u. Leipz., 
1906, xxix, 304. 

Meshtsherski, G. I. — Two cases of 
atypical syphilitic chancre — 
Prakt. Vrach, S. Petersb., 1906, 
v, 658. 

Meshtsherski, G. I. — Secondary 
syphilitic glycosuria — Prakt. 
Vrach, S. Petersb., 1909, viii, 
45. 

Metchnikoff, E. et Roux, E— Re- 
cherches mierobiologiques sur 
la syphilis — Clinique, Brux., 
1905, "xix, 806. 

Metchnikoff, E. — Experimental syph- 
ilis — Med. Mag., Lond., 1905, 
xiv, 512. 

Metchnikoff, E. — La syphilis ex- 
perimentale — Bull, de l'Inst. 
Pasteur, Paris, 1905, iii, 489- 
537. 

Metchnikoff, E. et Roux, E. — Etudes 
experimentales sur la syphilis — 
Ann. de l'Inst. Pasteur, Paris, 
1905, xix, 673-698. 

Metchnikoff, E. et Roux, E— Re- 
cherches mierobiologiques sur 
la syphilis — Bull. Acad, de med., 
Paris, 1905, 3 s. liii, 468-476. 

Metchnikoff, E. — La syphilis experi- 
mental — Arch. gen. de med., 
Paris, 1905, tome i, 1623-1638. 

Metchnikoff, E. et Roux, E— Re- 
cherehes mierobiologiques sur 
la syphilis — Syphils, Paris, 

1905, iii, 418-428. 
Metchnikoff, E, et Roux, E— Etude 

recherches sur la syphilis — 
Bull. Acad, de med., Paris, 

1906, 3s. Iv, 554-570. 



Metschnikoff, E. — Ueber syphilis- 
prophylaxe — Med. Klin., Berl., 
1906, ii, 371. 

Metchnikoff, E. — Sur la preserva- 
tion de la syphilis — Soc. franc, 
de prophyl. san. et mor. Bull., 
Paris, 1906, vi, 30-39. 

Metchnikoff, E. — La preservation de 
la syphilis — Rev. internat. de 
med. et de chir., Paris, 1906, 
xvii, 101. 

Metchnikoff, E. et Roux, E.— Etudes 
experimentales sur la syphilis — 
Ann. de l'inst. Pasteur, Paris, 
1906, xx, 785. 

Metchnikoff — Rapport sur la syph- 
ilis experimentelle — Verhandl. 
d. deutch. dermat. GesellscS - , 
Berl., 1907, 227-241. 

Metchnikoff, E. — Sur la prophylaxie 
de la syphilis — Ann. de l'Inst. 
Pasteur, Paris, 1907, xxi, 753- 
859. 

Mewborn, A. D. — A case of syph- 
ilitic inoculation from catheteri- 
zation of the eustachian tube — 
J. Cutan. Dis. incl. Syph., N. 
Y., 1905, xxiii, 175. 

Meyer, C. H. L. — Syphilis? Myelitis 
and peripheral neuritis; glyco- 
suria — Indian M. Gaz., Cal- 
cutta, 1905, xl, 179. 

Meyer, E. — Syphilis und trauma — 
Aerztl. Sachverst-Ztg., Berl., 
1905, xi, 425. 

Meyer, L. — Wann soil der arzt der 
Wassermannsehen serumreak- 
tion bedeienen ? — Allg. med. 
centr-ztg., Berl., 1909, lxxviii, 
119-121. 

Meyer, O. — Zur frage der silberspi- 
roehate — Centralbl. f. Bakte- 
riol., 1 Abt., Jena, 1908, xlvi, 
Orig. 319-321. 

Mezineescu, D. — Hodensyphilome 
bei kaninehen nach impfung mit 
syphilitischem virus — Deutsche 
med. Woch., Leipz. u. Berl., 
7909, xxxv, 1188. 

Mezzetti, G. — TJlcerazione gommosa 
della gamba presso il malleolo — 
Clin, dermosifilopat. d. r. Univ. 
di Roma, 1905, xxiii, 109. 

Mibelli, V. — L'etiologie della sifilide 
secondo le ultime scoperte para- 
sitologiche e sperimentali — 
Corriere san., Milano, 1907, 
xviii, 331. 



362 



Recent Bibliography. 



Mibelli, V. — Sul cosi detto periodo 
terziario della sifilide — Gior. 
ital. d. mal. ven., Milano, 1907, 
xlii, 393-410. 

Mibelli, V. — Sul cosi detto periodo 
terziario della sifilide — Cor- 
riere san., Milano, 1907, xviii, 
523-529. 

Mibelli, V. — On tbe so-called ter- 
tiary period of syphilis — Med. 
Obozr., Mosk., 1909, lxxi, 436- 
443. 

Michaelis, L. — Die Wassermannsche 
svphilisreaktion ■ — Berl. klin. 
Wchnschr., 1907. xliv. 1103- 
1107. 

Michaelis, L. — Pracipitinreaktion 
bei syphilis — Berl. klin. Woch., 
1907.' xliy. 1477. 

Michaelis. L. u. Lesser, F. — Erfahr- 
ungen mit der serodiagnostik 
der syphilis — Berl. klin. Woch., 
1908,' xlv, 301-303. 

Von Michel — Ueber die patho- 
logiseh-anatomisehen verander- 
ungen der lutgefiisse des augap- 
fels bei syphilis — Ztschr. f. 
Augcnh., Berl.. 1907, xviii. 205- 
299. 

Mieheli. F. e Borelli. L. — -Lo stato 
;i t tuale della siero-diagnosi 
della sifilide speeificita clinica 
della reazione del Wassermann 
— Path, riv., Genova, 1908-9, 
i. 107-113. 

Mieheli, F. e Borelli, L. — Osserva- 
zioni e richerche sulla siero- 
diagnoBi della sifilide — Riy. 
ci it. di e'in. nied.. Firenze, 1908, 
ix. 2S9-305. 

Mieheli. F. e Borelli. L. — Sulla 
aierodiagnoai della sifilide (rea- 
zione di Wassermann) — Gior. 
il. r. Accad. di nied.. Torino, 
190S, 4 s. xiv, 16-19. 

Mieheli, F. e Borelli. L. — Lo stato 
attuale della siero-diagnosi 
della sifilide — Path. riv.. Ge- 
nova, 1908-9. i. 125-130. 

Mieheli. F. e Borelli, L. — Lo stato 
attuale della siero-diagnosi 
della sifilide iii.. modalita tech- 
niche della reazione di Wasser- 
mann — Path. riv. quindicin, 
Genova, 1908-9, i, 185-194. 

Mieheli. F. e Borelli, L. — Lo stato 
attuale della sierodiagnosi 
della sifilide iv, natura della 
reazione di Wassermann — Path, 
riv. quindicin, Genova. 1908-9, 
i. 208-217. 



Miekley — Ein fall von nephritis 
specifica im sekundarstadium 
der syphilis — Charite Ann., 
Berl., 1908, xxii, 482-488. 

Miekly — Lues maligna mit hepatitis 
interstitialis — Berl. klin. 
Woch., 1909, xlvi, 130. 

MikhailofT, M. P. — Potassium as a 
reagent for diagnosis between 
tertiary syphilis and cancer of 
the internal organs inaccessible 
to exact physical examination 
— Rusak. Vrach, 8. Petersb., 
1906, v, 1573. 

Milan — Diagnostic elinique des 
gommes ( sporotrichese syphilis 
tuberculose) — Progres med., 
Paris, 1908. 3 s. xxiv, 236-239. 

Milan, G. — L'ultramicroscope et le 
diagnostico de la syphilis — 
Progres med., 1909, 3 s. xxv, 66. 

Milan, G. — De l'utilite des examens 
ultra-mieroscopiques dans le 
diagnostic des accidents syph- 
ilitiques en particulierement du 
chancre — Bull, et mem. soc. 
med. de hop. de Paris, 1909, 
3s. xxvi, 636-643. 

Milian — La syphilis secondaire tar- 
dive — Rev. d. hop. de France et 
de l'etrang., Paris, 1906, viii, 
No. 2. 1-3. 

Milio, I. — Le manifestazioni della 
sifilide congenita nei bambini — 
("Jazz, sicil. di med. e chi"-.. Pal- 
ermo, 1906, y. 533-538. 

Miller, C. M. — Tertiary syphilis of 
the nose and pharynx — Am. J. 
Dermat. and Genito-Urin. Dis.. 
St. Louis. 1909. xiii. 350-352. 

Millian, G. — Le spirochete decou- 
yert par Schaudinn dans la 
syphilis — Rev. d. hop. de France 
et de l'etrang, Paris, 1905, vii, 
No. 8, 1-3. 
i Millian, G. — La surveillance du sys- 
teme nerveux des syphilitiques 
— Rev. d. hop. de France et de 
l'etrang., Paris, 1907. ix, No. 
6, 1-4. 

Milman, M. S. — Omikrohie sifilisa — 
Russk. Vraeh. S. Petersb., 1906. 
v. 205-207. 

Mina*sian. P. — Rieherehe intorno 
alia spirocheta pallida — Riv. 
venata di sc. med.. Venezia, 

1906. xlv. 472-492, 1 pi. 
Minasoian. P. — Spirocheta pallida 

e sifiloma extragenital! — Riv. 
veneta di sc. med.. Venezia, 

1907, xlvi, 225-230. 






Recent Bibliography. 



363 



Minassian, P. — Trenta easi di sifi- 
loma extragenital! fra cui due 
aifiloma del naso — Riv. veneta 
di sc. med., Venezia, 1906, xlv, 
409-422. 

Minassian, P. — Sifllide acquisita 
(periodo primario e secondario) 
ed ereditaria rieherche istolo- 
giehe e parasitoligiche — Riv. 
veneta di sc. med., Venezia, 
1908, xlviii, 450, 493. 

Minassian, P. — Casistica sifilograflca 
— Riv. veneta di sc. med., Vene- 
zia, 1909, li, 364-370. 

Minelli, S. e Gavazzeni, G. A. — -La 
metodo di Porges nella siero- 
diagnosi della sifilide — Gazz. 
med. ital., Torino, 1909, lx, 191- 
194. 

Minet, J. et Verhaeghe, E. — Tibia 
geant en fourreau de sabre — 
Echo med. du nord, Lille, 1908, 
xii, 637. 

Minne, A. — Bacteriologie du chan- 
cre mou — Ann. Soc. de med. de 
Gand., 1905, lxxxv, 207. 

Mironovich. V. V. — Is there any 
basis for excluding pigmented 
syphilis from the list of para- 
syphilitic diseases? — Russk. j. 
kozhn. i. ven boliezn, Kharkov, 
1908, xvi, 80-90. 

Mironovich, V. V. — Early develop- 
ment of pigmented syphilis — 
Russk. j. kozhn. i. ven. boliezn, 
Kharkov, 1908, xv, 149-155. 

Miropolski, L. A. — Three cases of 
non-sexual syphilitic infection 
— Russk. j. kozhn. i. ven. bo- 
liezn, Kharkov, 1905, x, 19. 

Mish, S. C. — Relative influence of 
the parents in the transmission 
of syphilis — Am. J. Dermat. 
and Genito-Urin. Dis., St. Louis, 
1906, x, 232-234. 

Miyashima — The spirochaeta pallida 
— Saikingaku Zashi, Tokyo, 
1906, 1-17. 

Modder, E. E. — The transmission 
of yaws by ticks — J. Trop. M., 
Lond., 1907, x, 187. 

Moffitt, H. B. — Luetic stigmata of 
importance to the general prac- 
titioner—Calif. State J. M., 
San Fran., 1908, vi, 375-377. 

Mohan, F. G. — Tertiary syphilis- 
Colorado M., Denver, 1906, iii, 
275-277. 

Mohn — Berieht ueber spiroehatenbe- 
funde in der plazenta — Miinchen 
med. Woch., 1906, liii, 2334. 



Mohn, F. — Die veranderungen an 
placenta nabelschnur und ei- 
hauten bei syphilis und ihre be- 
ziehungen zur spirochajte pal- 
lida — Ztschr. f. geburtsch. u. 
gvnak., Stuttg., 1907, lix, 263- 
312. 

De Molenes, P. — Contribution a 
l'etude de la syphilis exotique — 
J. de med. et chir. prat., Paris, 
1909, lxxx, 849-857. 

Moller, M. — Zur frage von der an- 
steckungsvertragung der syph- 
ilis — Ztschr. f. Bekampf. d. 
Geschlechtskr., Leipz., 1907, vi, 
41, 87. 

Moller. M. — On the question is syph- 
ilis contagious — Hvgeia, Stock- 
holm, 1908, 2 F. v'iii, 1-20. 

Monckeberg, J. G. — Ueber die bezie- 
hungen zwischen syphilis und 
schweiliger aortensklerose vom 
pathologischanatomischen stand- 
punkt — Med. Klin., Berl., 1905, 
i, 1027. 

Monoorvo, Filho — Ensario para o 
estudo do microbio de Schaud- 
inn na syphilis hereditaria— 
Rev. de Soc. de med. e cirurg., 
Rio de Jan., 1905, ix, 249-274. 

Moncorvo, Filho — O espeirochaete 
pallida na syphilis hereditaria 
— Gaz. clin., S. Paulo, 1905, 
iii, 479. 

Moncorvo Filho — Un caso raro de 
syphilis — Brazil med., Rio de 
Jan., 1906, xx, 58-69. 

Moncorvo, Filho — Contributo alio 
studio del microbio di Schaud- 
inn nella sifilide eredetaria — 
Pediatria, Napoli, 1906, 2 s. iv, 
171-189. 

Monoorvo Filho — Um caso raro de 
syphilis infantil transmittido 
pelo seio materno — J. de med. 
de Pernambuco, 1909, v, 48. 

Moncorvo Filho — Um caso raro de 
syphilis infantil transmittida 
pelo-seio materno — Tribuna 
med., Rio de Jan., 1909, xv, 109- 
112. 
Monel, H — Les spirochetes dans le 
placenta — Soc. franc. de 
prophyl. san. et mor. Bull., 
Paris, 1906, vi, 352. 
Montemurro, G. — Sifilide ereditaria 
e sifilide da concepimento — Ras- 
segna d'ostet. e ginec, Napoli, 
1906, xx, 329, 337. 



364 



Recent Bibliography. 



Montgomery, D. W. — The acquisi- 
tion of syphilis professionally 
by medical men — J. Cutan. Dis. 
inch Svph., N. Y, 1905, xxiii, 
145-152. 

Montgomery, D. W. — The location 
of extragenital chancres — J. 
Cutan. Dis. incl. Syphilis, N. 
Y., 1905, xxiii. 342-355. 

Montgomery, D. W. — The convey- 
ance of syphilitic infection by 
medical men — Calif. J. M., San 
Fran., 1905, iii, 218. 

Montgomery, D. W. and Sherman, 
H. M. — A combination of syph- 
ilis and epithelioma of the 
tongue — J. Cutan. Dis. incl- 
Svph., N. Y.. 1906, xxiv, 564, 
3 pi. 

Morasawa and Ono — The spirochete 
as the cause of syphilis — Iji 
Shinburn, Tokio, 1905. 1725- 
1728, 1 pi. 

Morawetz, G. — Ueber einen fall von 
elephantiasis cruris auf luet- 
ischer basis — Med. Klin., Berl., 
1909, v, 1046. 

Moreau — Pseudo-hypopion gommeux 
syphilitique — Lyon med., 1908, 
ex. 858. 

Moreau et Rollet — Syphilides gom- 
meuses suivies d'ectropion cic- 
atriciel — Lvon med., 1908, ex, 
962-964. 

Morelle. A. — Les recherches sur la 
svphilis — Ann. d. l'lnst. chir. 
de Brux., 1906, xiii, 85-95. 

Morestin — Perforation palatine 
syphilitique: palatoplastie — 
Bull. Soc. franc, de dermat. et 
svph., Paris, 1907, xviii, 358- 
360. 

Morrow, P. A. — Prognosis of syph- 
ilis: relations to marriage and 
heredity — Med. News, N. Y., 
1905, lxxxvii, 436. 

Morrow. P. A. — The control of 
syphilis and venereal diseases — 
Boston M. and S. J.. 1907, clvi, 
169. 

Morrow — Late secondary syphilis — 
J. Cutan. Dis. incl. Syph., N. 
Y.. 1907. xxv. 267. 

Mosny et Malloizel — Un cas de pneu- 
monie blanche syphilitique chez 
l'adulte — Ann. d. mal. ven., 
Paris, 1907. ii, 732-739. 

Mott. T. W. — An address on the 
diagnosis of syphilitic diseases 
of the nervous svstem — Brit. 
M. J., Lond., 1909, 'i, 1403-1408. 



De la Motte, M. — Luesnachweis 
durch farhenreaction — Psychiat- 
neurol. Woch., Halle, a S. 1909- 
10, xi, 250. 

Moty — Syphilis ignoree — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1906, xvii, 25-27. 

Moty — Syphilis ignoree — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1906, xvii, 25-27. 

Moutot — Nouveau cas de vaste ul- 
ceration gommeuse heredo-syph- 
ilitique du genou — Lyon med., 

1906, cvii, 140-146. 

Much, H. u. Eichelberg, F. — Die 
komplementbildung mit wass- 
rigen luesextrakt bei nielit- 
svphilitischen krankheiten — 
Med. Klin., Berl., 1908, iv, 671- 
673. 

Much, H. — Eine studie ueber die 
sogenannte komplementbind- 
ungsreaktion mit besonderer 
berUeksichtigung der lues — Med. 
Klin.. Berl., 1908. iv, 1076-1079. 

Much, H. — Die praktische brauch- 
barkeit der Wassermannschen 
reaktion — Miinchen Med. Woch., 
1909. lvi, 1485. 

Mucha, V. u. Scherber, G. — Leber 
den nachweis der spiroehaete 
pallida im syphilitischen gewebe 
Wien klin. Wchnsch., 1906, xix, 
145-148. 

Mucha, V — Leber den nachweis der 
spiroehaete pallida im dunkel- 
feld— Med. Klin., Berl., 1908, iv, 
1498. 

Muhlens. P. — Lntersuchungen ueber 
spirochaeta pallida und einige 
andere spirochatenarten insbe- 
sondere in schnitten — Centralbl. 
f. Bakteriol.. 1 Abt., Orig., Jena, 

1907, xliii, 586, 674, 2 pi. 
Muhlens, P. — Beitrag zrir experimen- 

tellen kaninchenhornhautsyph- 
ilis — Deutsche med. Wchnchr., 
Leipz. u. Berl., 1907, xxxiii, 
1207. 

Muhlens — Reinzflchtung einer spiro- 
chate (spirochaeta pallida) aus 
einer syphilitischen druse — 
Deutsche med. Woch , Leipz. u. 
Berl., 1909, xxxv, 1261. 

Muhlmann, M. — Leber die neueren 
untersuchungen beziiglich der 
syphilitischaetiologie — Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena, 1906, xxxviii, 650, 1 pi. 



Recent Bibliography. 



365 



Muller, M. — Die serodiagnostik dei 
syphilis und ihre bedeutung fur 
die praxis — Strassb. med. Ztg., 
1908, v, 241-250. 

Muller, 0. — Ueber einen fall von 
aussergewohnlich friihzeitigen 
auftreten von hautgummata — 
Deutsche med. Woch., Leipz. u. 
Berl., 1909, xxxv, 1230. 

Muller, R. — Zur verwertbarkeit und 
bedeutung der komplementbind- 
ungs reaktion fur die diagnose 
der syphilis — Wien klin. Woch., 
1908, xxi, 282-287. 

Muller, J. — Syphilis und ehe — 
Wurzb. Abhandl a. d. Gesamt- 
geb. d. prakt. med., 1909, ix, 
185-201. 

Muller, R. — Die bedeutung der sero- 
diagnose der syphilis fiir den 
arzt— Wien med. Woch., 1908, 
lviii, 2796-2800. 

Muller, H. — Spirochete pallida sam- 
melreferat— Deutsche Med-Ztg., 
Berl., 1905, xxvi, 724. 

Muller, H. — Ueber die spirochete 
pallida — Deutsche med-Ztg., 
Berl., 1907, xxviii, 205. 

Mulzer, P. — Ueber das vorkommen 
von spirocheten bei syphiliti- 
schen und anderen krankheits- 
produktion — Berl. klin. Woch., 
1905, xlii, 1144. 

Mulzer, P. — Sammeireferat ueber 
spirochetenbefunde bei syphilis 
— Arch. f. Dermat. u. Syph., 
Wien u. Leipz., 1906, Ixxix, 387- 
424. 

Mundorff, G. T. — A case of deep- 
seated urethral chancre, with 
notes — Am. Therapist, N. Y., 
1904-5, xiii, 203. 

Munro, W. J. — Note on the spiro- 
cheta pallida of Schaudinn 
and Hoffmann — Australas. M. 
Gaz., Sydney, 1905, xxiv, 637- 
639. 

Munro, W. J. — Some observations 
upon the microbiology of syph- 
ilis — Australas. M. Gaz., Syd- 
ney, 1906, xxv, 341. 

Munro, W. J. — Three primary simul- 
taneous syphilitic lesions — Aus- 
tralas. M. Gaz., Sydney, 1906, 
xxv, 458. 

Murel — Chancre indure quintuple — 
Marseille med., 1906, xliii, 11. 

Muren, G. M. — Reports of two cases 
of syphilis — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1905, ix, 333. 



Murero, G. — Spirochete; mercurio e 
iodio rieherche sperimentali e 
diluzioni — Gior. ital. d. mal. 
ven., Milano, 1907, xlviii, 648- 
659, 1 pi. 

Murrell, T. W.— Syphilis in the 
negro; its bearing on the race 
problem — Am. J. Dermat and 
Genito-Urin. Dis., St. Louis, 
1906, x, 305-307. 

Murrell, W. — Some phases of syph- 
ilis, especially the larval syph- 
ilis of women — Med. Press and 
Circ, Lond., 1905, ns. lxxx, 370. 

Musham, H. — Die klinische leistungs- 
fahigkeit der serodiagnostik bei 
lues — Berl. klin. Woch., 1908, 
xlv, 14. 

Mutermilch, S. — Sur la nature des 
substances qui provoquent la re- 
action de Wassermann dans les 
serums des syphilitiques et des 
lapins trypanosomies — Compt. 
rend. soc. de biol., Paris, 1909, 
lxvi, 125-127. 



N 



Naegeli-Akerblom u. Vernier — Zur 
diagnose der syphilis — Therap. 
Monatsh., Berl., 1908, xxii, 200- 
203. 

Nagelschmidt, F. — Ueber eine nach- 
weisestelle syphilitischer — Am- 
men. Med. Klinik, Berl., 1907, 
iii, 181. 

Nageotte, J. — A propos de la com- 
munication de Ravaut et Pon- 
selle sur la presence du spiro- 
chete pale dans les noyaux des 
cellules de l'ependyme au cours 
de la syphilis — Bull. et. mem. 
Soc. med. d. hop. de Paris, 1907, 
3 s. xxiv, 1596-1599. 

Nattan-Larrier, L. et Bergeron, A. — 
Presence du spirochete pallida 
dans le sang des syphilitiques — 
Presse med., Paris, 1906, xiv, 
19. 

Nattan-Larrier, L. et Brindeau, A. — 
Presence du spirochete pallida 
dans le placenta syphilitique — 
Compt. rend. Soc. de biol., Paris, 
1906, lx, 181. 

Nattan-Larrier, L. et Levaditi, C. — 
Reeherches microbiologiques et 
experimentales sur le pian — 
Compt. rend. Soc. de biol., Paris, 
1908, Ixiv, 29-31. 



366 



Recent Bibliography. 



Neisser, A. u. Baermann, G. — Ver- 
suchen zur uebertragung der 
syphilis auf alTen — Deutsche 
med. Woch., Leipz. u. Berl., 

1905, xxxi, 748. 

Neisser — Ueber experimentelle syph- 
ilis bei affen — Berl. klin. 
Wchnschr., 1!)06, xliii, 373. 

Neisser — Syphilisonderzoek — Nederl. 
Tijdschr. v. Geenesk, Arnst., 

1906, i, 1963-1970. 

Neisser, A., Baermann, G. u. Halber- 
stadter — Versuche zur ueber- 
tragung der syphilis auf affen — 
Deutsche med. Wchnschr., Leipz. 
u. Berl., 1906, xxxii, 1, 49-97. 

Neisser, A., Bruek, C. u. Schucht, A. 
— Diagnostische gewebe und 
blutuntersuchungen bei syphilis 
— Deutsche med. Woch., Leipz. 
u. Berl., 1906. xxxii, 1937-1942. 

Neisser — Ueber den derzeitigen 
stand der experimentellen syph- 
ilisforschung — Deutsche med. 
Woch., Leipz. u. Berl.. 1906. 
xxxii, 1687. 

Neisser — Syphilisforschungen auf 
Java — Mitt. d. deutsch. Ge- 
sellsch. z. Bekampf. d. Ge- 
sehleehtskr., Leipz.. 1906, iv, 
60-67. 

Neisser— Die NVisserschen syphilis- 
forschungen auf Java — Ztschr. 
f. Bekampf. d. Geschlechtskr., 
Leipz.. 1906. v, 261-282. 

Neisser — Syphilis experimentelle 
(Transl.) — Snc. franc, d« 
prophyl. san. et mor. Bull., 
Paris.' 1906, vi, 182-189. 

Neisser — Ueber seine in Batavia 
angestollten untersuchungen 
ueber syphilis — Ztschr. f. ang. 
Mikr.. Leipz., 1906, xii. 6-8. 

Neisser. A. — The present position of 
our knowledge of the etiology of 
syphilis — Am. J. Dermat. and 
Genito-Urin. Dis.. St. Louis. 

1907, xi. 53. 

Neisser. A. — Die experimentelle 
syphilisforsehung nach ihrem 
gegenwartifen stande — Ver- 
handl. d. deutsch. dermat. Ges- 
sellsch.. Berl.. 1007. 1-114. 

Neisser. A. — Fin beitrag zur lehre 
von der kaninchen syphilis — 
Dermat. Ztschr.. Berl.. 1908. xv, 
73-79. 

Neisser. A. — La sifilide considerata 
specialmente dal 'lato sperimen- 
tale — Salute pubb.. Perugia. 

1908, xxi, 281-291. 



Neisser. A. — Sind syphilis und fram- 
bosie verschiedene krankheiten? 
— Arch. f. Schiffs-u. Tropen- 
Hyg., Leipz., 1908, xii. 173-179. 

Neisser, A. — Syphilis with special 
reference to experimental work 
on the subject— Brit. M. J., 
Lond., 1908, ii, 1085-1089. 

Neisser, A. — Etat actuel des progres 
de la syphilographie moderne 
— Ann. d. mal. ven., Paris, 1908, 
iii, 641-663. 

Neisser. A. — Lupus oder tertiaire 
lues? Sarkom oder primare 
lues?— Berl. klin. Woch., 1909, 
xlvi, 1517. 

Neisser — Bericht ueber die in Java 
angestellten experimentellen 
syphilisforschungen — Verhandl. 
d. deutsch. dermat. Gesellsch., 
Berl., 1908, x, 137-144. 

Nemicic. S. — Spirochsete pallida 
(Schaudinn) — Lijec vijestnik u. 
Zagrebu, 1906, xxviii, i64-169. 

Neuberg — Leber die kontagiosit&t 
der spitzen c o n d y 1 o me — 
Deutsche med. Wchnschr., Leipz. 
u. Berl., 1907, xxxiii, 1415. 

Neuberger, J. — Ueber unschuldig er- 
worbene syphilis — Hvg. Bl., 
Berl., 1907.' iii, 14, 5-150. 

Neumann, H. u. Oberwarth, E. — 
Hiiufigkeit der hereditaren 
Byphilis — Arch. f. kinderh., 
Stuttg.. 1905, xlii, 64. 

Von Neumann, I. — Ueber die bis- 
herigen ergebnisse der uebertra- 
gung der syphilis auf affen — 
Wien klin. Woch., 1906, xix, 
1447. 

Von Neumann. I. — Zur aetiologie 
des syphilisrezidivus — Deutsche 
Klin-therap. Woch., Leipz., 
1905, iii, 521. 

Von Neumann, I. — Zur aetiologie 
des syphilisrezidivus — Deutsche 
klin-therap. Woch., Leipz., 1906, 
iii, 556. 

Neumann, J. — The etiology of re- 
lapses in syphilis — Med. Age, 
N. Y., 1906," lxix, 649. 

Neumann, J. — Ueber die an den al- 
terperuanisehen kermaniken 

und dargestellten hautverander- 
ungen mit besonderer riicksieht 
auf das alter der syphilis und 
anderer dermatosen — Denkschr. 
d. Akad. d. Wissensch. math- 
naturw. Kl. Wien, 1906, lxxviii, 
492-501, 3 pi. 



Recent Bibliography. 



367 



Newborn, A. Di — Initial lesion of 
the eyelid — J. Cutan. Dis. incl. 
Syph., N. Y., 1905, xxiii, 167. 

Newborn — A case of diffuse miliary 
papular syphilide, with tumors 
in lumbar and mammary re- 
gion ( gummata ? ) — J. Cutan. 
Dis. incl. Syph., N. Y., 1907, 
xxv, 182. 

Newborn — Chancre of the gums — J. 
Cutan. Dis. incl. Syph., N. Y., 
1907, xxv, 184. 

Newman, B. D. — Syphilitic fever 
with report of a case — Med. 
Eec, N. Y., 1908, lxxiii, 140- 
142. 

Nicola, B. — Sulla oosiddetta reazione 
di Justus nella sifilide— -Gior. d. 
r. Accad. di med. di Torino, 
1907, 4 s. xiii, 185-189. 

Nicolas, J., Favre, M. et Andre, C. — 
Micro-photographies du spiro- 
chete de Schaudinn et Hoffmann 
faites par M. M. Lumiere — Bull. 
Soc. med. d. hop de Lyon, 1905, 
iv, 291. 

Nicolas, J., Favre, M. et Andre, C. — 
Spirochsete pallida de Schaud- 
inn et Hoffmann — Bull. Soc. 
med. d. hop. de Lyon, 1905, iv, 
258. 

Nicolas, J. et Favre, M. — Syphilis 
hereditaire simulant des aden- 
ites et des arthrites serofulo- 
tuberculeuses — Bull. Soc. med. 
d. hop. de Lyon, 1905, iv, 186. 

Nicolas, J., Favre, M. et Andre, C. — 
Microphotographies du spiro- 
chsete de Schaudinn et Hoff- 
mann faites par M. M. Lumiere 
— Lyon med., 1905, cv, 122. 

Nicolas, J., Favre, M. et Andre, C. — 
Syphilis et spirochete pallida 
de Schaudinn et Hoffmann — 
Lyon med., 1905, cv, 497-513. 

Nicolas, J. et Favre, M. — Syphilis 
hereditaire simulant des aden- 
ites et des arthrites serofulo- 
tuberculeuses — Lyon med., 1905, 
civ, 1141. 

Nicolas, J., Favre, M. et Andre, C. — 
Spirochetal pallida de Schaud- 
inn et Hoffmann — Lyon med., 
1905, civ, 1366. 

Nicolas, J., Durand, M. et Moutot, 
H. — Dactylite syphilitique a 
forme de tumeur des gaines 
avec recidive d'appearance sar- 
comateuse ■ — Lyon med., 1908, 
ex, 851-856. 



Nicolas, J. et Favre, M. — Sur un 
cas de syphilides ulcereuses a 
cicatrisation cheloidienne — 
Lyon med., 1906, cvii, 119-122. 

Nicolas, J. et Favre, M. — Sur la 
presence du spirochaete dans le 
foie d'un heredo-syphilitique — 
Lyon med., 1906, cvi, 189. 

Nicolas, J. et Favre, M. — Rapport 
sur les recherches experimen- 
tales recentes concernant la syph- 
ilis — Lyon med., 1906, cvi, 754. 

Nicolas, J. — Chancres syphilitiques 
extra-genitaux ; multiples chan- 
cres du menton et de la voute 
palatine — Lvon med., 1906, cvi, 
905. 

Nicolas, J. — Sur un cas de syphilis 
gommeuse hereditaire tardive — 
Lyon med., 1906, cvi, 1198-1201. 

Nicolas, J. — Syphilis secondaire et 
ulcerations de la voute palatine 
et des amygdales avec associa- 
tion fuso-spirillaire — Lyon med., 
1906, cvi, 1287-1289. 

Nicolas, J. et Favre, M. — Coloration 
du treponema (spirochete) de 
Schaudinn dans les organes; 
presentation de coupes d'un foie 
d'heredo-syphilitique — Bull. Soc. 
med. d. hop. de Lyon, 1906, 
v, 4. 

Nicolas, J. et Favre, M.— Un cas de 
syphilis tertiaire a manifesta- 
tions gommeuses multiples — 
Bull. Soc. med. d. hop. de Lyon, 
1906, v, 134-136. 

Nicolas, J. et Favre, M. — Rapport 
sur les recherches experimen- 
tales recentes concernant la 
syphilis — Bull. Soc. med. d. 
hop. de Lyon, 1906, v, 154. 

Nicolas, J. — La syphilis etat actuel 
de son etude experimentale — 
Bull, med., Paris, 1906, xx, 713- 
715. 

Nicolas, J. — Le spirochete de 
Schaudinn et Hoffmann trepo- 
nema pallidum — Med. mod., 
Paris, 1906, xvii, 237-239. 

Nicolas, J. — Gommes syphilitiques 
precoces — Lyon med., 1907, 
cviii, 1083. ' 

Nicolas, J. — Syphilis secondary 
maligne et tertiaire precoce; 
doigts hippocratiques — Lyon 
med., 1907, cviii, 1181-1183. 

Nicolas, J. et Laurent, C. — Syphil- 
ides tertiaires acneiques du nez 
— Lyon med., 1909, cxii, 280. 



368 



Recent Bibliography. 



Nicolas, J. et Favre, M. — Contribu- 
tion a l'bistologie pathologiques 
des syphilides tertiaires cu- 
tanees (cellules) geantes e fol- 
licule (syphilitique) — Ann. d. 
mal. ven , Paris, 1907, ii, 401- 
447. 

Nicolas, J. — Etiologie de la syphilis 
acquise et chancre syphilitique 
J. de med. int., Paris, 1907, xi, 
- 339-359. 

Nicolas et Favre — Sur l'existence de 
cellules geantes dans les syph- 
ilides tertiaires des muqueuses 
Bull. Soc. med. d. hop. de 
Lyon. 1907. vi, 310-312. 

Nicolas, J. et Favre, M. — Sur l'ex- 
istence de cellules geantes dans 
les syphilides tertiaires des 
muqueuses — Lyon med., 1907, 
cix, 1074-1076.' 

Nicolas. J. et Favre, M. — Cellules 
geantes et follicule syphilitique 
dans les syphilides tertiaires 
cutanees et muqueuses; ces for- 
mations liistologiques permet- 
tant-elles de distinguer avec cer- 
titude la tuberculose de la syph- 
ilis — Prov med., Paris. 1907, 
xx, 635-638. 

Nicolas, J., Durand. M. et Moutot, 
H. — Daetylite syphilitique a 
forme de tumeur des gaines 
avec recidive d'appearance sar- 
comateuse — Ann. de dermat. et 
svph.. Paris. 1908, 4 s. ix, 208- 
214. 

Nicolas. J. et Favre, M. — Cellules 
geantes et follicule syphilitique 
dans les syphilides tertiaires 
cutanees et muqueuses les for- 
mations liistologiques permet- 
tent-elles de distinguer avec 
certitude la tuberculose de la 
syphilis? — J. med. franc, Paris, 
1908, ii, 21-28. 

Nicolas, J. et Moutot, H. — Chancres 
extra-genitaux multiples et suc- 
cessif s ( deux chancres de la 
langue un chancre de la voute 
palatine un chancre du dos de 
la main un chancre de la levre 
inferieure) — Ann. d. mal. rev., 
Paris, 1909, lv, 189-192. 

Nicolas, J. et Favre, M. — Treponema 
pallidum de Schaudinn et Hoff- 
mann examine vivant au moyen 
de l'ultra-microscope — Lyon 
med., 1909, cxiii, 37. 



Nicolas, J. et Favre, M. — Histologic 
et histogenese d'un nodule syph- 
ilitique cutane; role de la 
phlebite syphilitique dans son 
developpenient — Bull. Soc. med. 
1909, cxii, 613-619. 

Nicolas, J. et Laurent, C. — Syphilis 
hereditaire tardive adenites eer- 
vicales suppurees osteo-arthrite 
metatarso-phalangienne avec 
elimination de sequestre syph- 
ilides verruqueuses du nos des 
pieds et syphilides tuberculo- 
ulcereuses disseminees — Bull. 
Soc. med. d. hop. de Lvon, 1909, 
viii. 18-20. 

Nicolas, J. et Laurent, C. — Syph- 
ilides tertiaires acneiques du 
nez — Bull. Soc. med. d. hop. de 
Lyon, 1909, viii, 46. 

Nicolas, J. et Favre, M. — Histologic 
et histogenese d'un nodule syph- 
ilitique cutane; role de la 
phlebite syphilitique dans son 
developpement — Bull. Soc. med. 
d. hop. de Lyon. 1909, viii, 147- 
154. 

Nicolas. J. et Favre, M. — Treponeme 
pallidum de Schaudinn et Hoff- 
mann examine vivant au moyen 
de l'ultramicroscope — Bull. Soc. 
med. d. hop. de Lvon. 1909, 
viii, 277. 

Nicolau, S. G. — Present condition of 
the question of virulence of the 
sperm of syphilitic individuals, 
with some considerations on 
hereditary syphilis — Spitalul, 
Bucuresci. 1907. xxvii. 369-379. 

Nicols. J. B. — The etiology of syph- 
ilis — Am. J. Dermat. and Gen- 
ito-Urin. Dis., St. Louis, 1906, 
x. 143. 

Nicoletopoulos — La dyscataposie 
doloureuse comme signe de la 
syphilis — Bull. de laryngol. 
otol, et rhinol., Paris, 1907, x, 
273. | 

Nielsen, L. — Papular-erosive syphilis 
of the mouth and swelling of a 
dried spirocheta pallida about 
nine years after infection — 
I'gesk. f. Laeger, Kjobenh, 
1909, lxxi, 57-60. 

Nielsen. L. — Annulates syphilid im 
rande der narbe nach der in- 
duration — Monatsch. f. prakt. 
Dermat., Hamb., 1908, xlvi, 
225-227. 






Recent Bibliography. 



369 



Nielsen, L. — Annulat syphilid ran- 
den af arret efter indurationen 
— Hosp. Tid., Koben.li., 1908, 5 
R. i, 39-41. 

Von Niessen — Die ergebnisse meiner 
12-ja.hrigen experimentellen stu- 
dien der syphilisatiologie — Kor- 
Bl. d. allg, iirztl. Ver v. Thur- 
ingen, 1905, xxxiv, 171. 

Von Niessen — Mutabilitat und gen- 
erationswechsels des syphilis- 
bacillus als ursache der varia- 
blen syphiliserseheinungen — 
Med. Woche, Berl., 1905, vi, 
201. 

Von Niessen — Der heutige stand der 
syphiliserkenntniss — Med. 
Woche, Berl., 1905, vi, 337. 

Von Niessen — Der heutige stand der 
syphiliserkenntnis — Med. 
Woche, Berl., 1905, vi, 345, 363, 
379. 

Von Niessen — Die ergebnisse meiner 
12-jiihrigen experimentellen stu- 
dien der syphilisatiologie — Ver- 
handl. d. Kong. f. innere Med., 
Wiesb., 1905, xx, 426-437. 

Von Niessen — Die ergeznisse meiner 
1-jahrigen experimentellen stu- 
dien der syphilisatiologie — 
Munchen med. Woch., 1905, Hi, 
979. 

Von Niessen — Die bedeutung der 
spirocheta pallida fur die syph- 
ilisursache und syphilisdiagnose 
— Wien med. Woch., 1906, Ivi, 
1344. 

Von Niessen — Die serodiagnostik der 
syphilis — Med. Woche, Halle, 

1906, vii, 329, 341. 

Von Niessen — Syphilis beim kanin- 
chen erzeugt mit der reinkultur 
des kontagium — Wien med. 
Wehnschr., 1908, lviii, 2524- 
2578. 

Von Niessen, M. — Syphilis beim kan- 
inchen erzeugt mit der reinkul- 
tur des syphilisbacillus von 
Niessen — Internat. Dermat. 
Cong. Tr., N. Y., 1908, ii, 749- 
762. 

Nigris, G. — Spirochete pallida und 
refringens neben einander im 
blute bei hereditarer lues — 
Deutches med. Woch., Leipz. u. 
Berl., 1905, xxxi, 1431. 

Niosi, F. — Per la diagnosi di una 
non commune lesione sifilitiea 
gommosa sotto-cutanea dell arto 
inferiore — Clin, med., Firenze, 

1907, xiii, 345-362. 



Nista, V. — Alterazioni anatomo- 
pathologische ed istologische dei 
gangli linfatici nella sifilide 
congenita — Gior. internaz. d. 
sc. med., Napoli, 1907, ns. xxix, 
481-494. 

Nixon, J. A. — Acquired syphilis in 
an infant with transmission to 
the mother — Brit. M. J., Lond., 

1907, ii, 389. 

Noailles — Syphilis tertiaire ulcera- 
tions multiples des os, parietaux 
gomme uleeree du lobe para 
central ramollissement sur aigue 
de toute la capsule interne — 
Union med. nord-est, Reims, 

1908, xxxii, 82-85. 

Noble u. Arzt — Zur serodiagnostik 
der syphilis — Wien klin. Woch., 

1908, xxi, 287-291. 
Noblecourt, Levadite et Darre — 

Syphilis congenitale et spiro- 
chsetae pallida Schaudinn — - 
Compt. rend. soc. de biol., Paris, 
1905, lviii, 1021. 

Noica — Citodiagnosticul in paralis- 
ule faciale periferice de origina 
sifilitea — Spitalul, Bucarest, 
1905, xxv, 331. 

Nobl — Ueber autoinokulationen in 
der 2. inkubation — A r erhandl. d. 
deutsch. dermat. Gesellsch., 
Berl., 1907, 270-276. 

Noeggerath, C. T. u. Staehelin, R. — 
Zum nachweis der spirochete 
pallida im blute syphilitischer 
— Munchen med. Woch., 1905, 
Hi, 1481. 

Noguchi, H. — Some critical consid- 
erations on the serum diagnosis 
of syphilis — Proc. Soc. Exper. 
Biol, and Med., N. Y.,. 1908-9, 
vi, 77-81. 

Nogushi, H. — Methode novelle et 
simple pour le serodiagnostic de 
la syphilis — Compt. rend. soc. 
de biol., Paris, 1909, Ixvi, 456. 

Noguchi, H. — Eine fur die praxis 
geeignete leicht ausfuhrbare 
methode der serumdiagnose bei 
svphilis — Munchen med. Woch., 

1909, lvi, 494-497. 

Noguchi, H. — The relation of pro- 
tein lipoids and salts to the 
Wasermann reaction — J.Exper. 
M., Lancaster, Pa., 1909, xi, 
84-99. 

Noguchi, H. — A new and simple 
method for the serum diagnosis 
of syphilis — J. Exper. M., Lan- 
caster, Pa., 1909, xi, 392-401. 



370 



Recent Bibliography. 



Noguchi, H. and Moore, J. W. — The 
butyric acid test for syphilis in 
the diagnosis of metasyphilitic 
and other nervous disorders — J. 
Exper. M.. Lancaster, Pa., 1909, 
xi, 604-613. 

Noguchi. H. — The fate of the so- 
called syphilitic antibody in the 
precipitin reaction — Proc. Soc. 
Exper. Biol, and Med., N. Y., 
1909-10, vii, 16. 

Noguchi, H. — The serodiagnosis of 
syphilis — J. Am. M. Ass., Chi- 
cago, 1909, liii, 934-936. 

Noguchi, H. — A rational and sim- 
ple system of serodiagnosis of 
syphilis — J. Am. M. Ass., Chi- 
cago, 1909, liii, 1532-1535. 

Noguchi, H. — Complement fixation 
test in the diagnosis of syph- 
ilitic and metasyphilitic condi- 
tions — Arch. Diag., N. Y., 1909, 
ii, 229-237. 

Nongues, M. I.- — Sero-diagnostico de 
la sifilis — Rev. espan. de der- 
mat. v sif., Madrid, 1909, xi, 
390-402. 

Nongues. I. — Sero-diagnostico de la 
sifilis — Rev. san. y. med. mil. 
espan., Madrid, 1909, iii, 480- 
505. 

Nord. F. G. and Knapp, R. E — 
Spirochete Obermeiri — J. Am. 
M. Ass., Chicago, 1906, xlvi, 
116. 

Nordin, A. — Le microbe de la syph- 
ilis — Rev. clin. d'androl et de 
gynec. Paris. 1905, xi, 200. 

Norris, C. — A case of spirochetal 
infection in man (Abstr.) — Am. 
Med., Phila., 1905, x, 912. 

Norris, C. — A ease of spirochetal 
infection in man, with demon- 
strations — Science, N. Y., and 
Lancaster, Pa., 1905, ns. xxii, 
635. 

Notthafft. A. — Chancre in the male 
— Urologia, Budapest, 1905, 4- 
11. 

Von Notthafft — Nochmals die bei- 
trage zur legende von der alter- 
tumssvphilis eine berichtigung 
— Dermat. Ztschr., Berl., 1908, 
xv. 49-51. 

Von Notthafft — Die legende von der 
praecolumbianschen syphilis der 
alten welt — Verhandl. d. Ge- 
sellseh. deutsch. naturf. u. 
aerzte. Leipz., 1909, 2 teil, 2 
hfte., 121-125. 



Von Notthafft — Die legenden von 
der altertumssyphilis—- Festchr. 
f. G. E. v. Rindrleisch, Leipz., 
1907, 377-592. 

Von Notthafft — Beitrage zur legende 
von der altertumssyphilis — 
Dermat. Ztschr., Berl., 1907, 
xiv, 603-651. 

Noyes, A. W. F. — The ratio of the 
various skin and mucous mem- 
brane lesions of syphilis — Aus- 
tralas. M. Cong. Tr., Victoria, 
1909, iii, 151. 



Oberwarth — Vorstellung eines falles 
von congenitaler syphilis mit 
spontanfrakturen — Berl. klin. 
Woch., 1906, xliii, 683. 

Oberwarth, E. — Zur kenntnis der 
Hutchinsonschen Zahne; ein 
beitrag zur klinik der heredo- 
syphilis — Jahrb. f. Kinderh., 
Berl., 1907, lxxi, 220-231. 

Obregia, A. et Bruckner, J. — Resis- 
tance 3 la putrefaction de l'an- 
ticorps syphilitique — Compt. 
rend. soc. de biol., Paris, 1909, 
lxvi, 482-484. 

Ochsncr, E. H. — The diagnostic 
value of potassium iodide in 
syphilis — Ann. Surg., Phila., 

1906, xliv, 623-625. 
Oettinger et Malloizel — De la pleur- 

opathie de la periode secondaire 
de la syphilis — Ann. d. mal. 
ven.. Par'is, 1906, i, 81-95, 1 pi. 
Ogilvie. G. — Cfllles' law and its ex- 
ceptions — Med. Brief, St. Louis, 

1907. xxxv. 753-756. 

Ogilvie, G. — Colics' law and its ex- 
ceptions — Med. Brief, St. Louis, 
1007. xxkv, 661-667. 

Ohm. J.— Ueber icterus syphiliticus 
— Charite-Ann., Berl., 1907, 
xxxi, 87-105. 

Ohmann-Dumesnil, A. H. — The 
stages of syphilis — Am. J. Der- 
mat. and Genito-Urin. Dis., St. 
Louis. 1906. x, 150. 

Ohmann-Dumesnil, A. H. — An un- 
solved problem in syphilogy — 
St. Louis M. and S. J., 1906, xc, 
227-230. 

Ohmura. T. — Silver impregnation 
methods of spirochete pallida 
in streak preparations — Hif- 
ukwa kiu Hinjokikwa Zasshi, 
Tokyo. 1907. vii. 427-436. 



Recent Bibliography. 



371 



Olio, 0. — Histological preparations 
of spirochete pallida — Hifukwa 
kiu Hiniokikwa Zasshi, Tokyo, 
1907, vii, 423-427. 

Oltramere, H. — Un cas de reinfec- 
tion syphilitique — J. d. mal. 
cutan. et syph., Paris, 1905, 
xvii, 92. 

Oltramare, H. — Des chancres syph- 
ilitiques non suivis d'accidents 
secondaires — Ann. de dermat. et 
syph., Paris, 1907, 4 s. viii, 246- 
253. 

Omelchenko, F. Z. — Spirochaete in 
syphilis — Russk. Vrach, St. 
Petersb., 1905, iv, 913. 

Omelchenko, F. Z. — Spirochaete in 
syphilis — Russk. Vrach, St. 
Petersb., 1906, v, 1105-1107. 

Opitz, E. — TJeber die bedeutung der 
Wassermannschen luesreaktion 
fiir die geburtshilfe — Med. 
Klin., Berl., 1908, iv, 1137. 

Oplatek, K. — Ueber reinfectio syph- 
ilitica— Wien klin. Woch., 1907, 
xx, 441. 

Oppenheim, M. u. Sachs, O. — Eine 
einfache und schnelle methode 
zur deutlichen darstellung der 
spirochaete pallida ■ — ■ Deutsche 
med. Woch., Leipz. u. Berl., 
1905, xxxi, 1154. 

Oppenheim, M. u. Sachs, O.— Ueber 
spirochaetenbefunde in syphiliti- 
schen und anderen krankheits- 
produkten — Wien. klin. Woch., 
1905, xviii, 1177. 

Oppenheim, M. — Der gegenwartige 
stand der syphilislehre — Wien 
med. Woch., 1906, lvi, 2152- 
2164. 

Oppenheimer, R. — Riesenleberzellen 
bei angeborener syphilis— Vir- 
chow's Archiv. f. Path. Anat., 
Berl., 1905, clxxxii, 237-257, 
lpl. 

Ortali, C. — II morbo di roger eredo- 
sifilitico — Risveglio med., Pes- 
cara, 1906, i, 24-39. 

Orton, S. T. — A study of the patho- 
logical changes in some mound; 
builders' bones from the Ohio 
Valley, with especial reference 
to syphilis — Univ. Penn. M. 
Bull., Phila., 1905-6, xviii, 36. 

Osier, W. and Churchman, J. W. — 
Syphilis — In Mod. Med. (Os- 
ier), Phila. and N. Y., 1907, iii, 
436-521. 



Ossola, S. — Sifiloma alio scroto di 
coniglio ottentuo con materiale 
di cheratite sifilitica sperimen- 
tale di coniglio — Boll. d. sc. 
med-chir. di Pavia, 1908, xxii, 
179-182. 

Ossola, S. — Sulle sieroreazioni di 
Wassermann e di Porges nei 
conigli sifilitici — Biochim. e 
terap. sper., Milano, 1909, i, 
265-271. 

Ostina, G. — Sulle sifilidi latenti ed 
ignorate dell' orecchio del naso 
e della gola — Gior. med. d. r. 
esercito, Roma, 1905, liii, 801. 

Otto, C. — The first symptoms of in- 
volvement of the nervous sys- 
tem in syphilis — Przegl. chorob. 
skor. i. wen., Warszawa, 1908, 
iii, 1-24. 

Ovazza, V. E. — Ictere et syphilis 
hereditaire — Arch, de med. d. 
enl, Paris, 1905, viii, 340-348. 

Overy — Congenital syphilitic liver 
and cystic kidneys — Tr. Hun- 
terian Soc, Lond., 1905, 99. 

Ozenne, E. — Du role de la syphilis 
dans le cancer — Clin. prat. med. 
d. yeux du larynx, Paris, 1908, 
iv, 41-53. 



Pacciarini, A. — Sifilide ignorata — 
Gazz. d. osp., Milano, 1907, 
xxviii, 1549. 

Pacini — Sulla permanenza della spi- 
rochete pallida in una papula 
sifilitica — Gior. ital. d. mal ven., 
Milano, 1906, xli, 529. 

Pacyna, J. — Rare localization of the 
first stage of syphilis — Przegl 
lek, Krakow, 1906, xlv, 456. 

Paganelli, T. R. — A case of tertiary 
syphilis having the appearance 
of lupus vulgaris — J. Med. Soc, 
N. Jersey, Orange, 1909-10, vi, 
349. 

Paisant, R. — Discussions des conclu- 
sions du rapport sur la question 
la syphilis peut-elle etre par 
elle-meme une cause de divorce? 
— -Soc. franc, de prophyl. san. 
et mor. Bull., Paris, 1909, ix, 
59-80. 

Palander, E. — The spirochaete pal- 
lida and its relation to the eti- 
ology of syphilis- — Duodecim, 
Helsinki, 1905, xxi, 232-249. 



372 



Recent Bibliography. 



Palem, M. A. — Dystrophy of th; 
teeth of hereditary syphilitic 
origin — Zubo>racl. vestnik, St. 
Petersb., 1905, xxi, 180. 

Panella. A. — Siflloderma roseolico 
di repetizione (roseola recidi- 
vate) — Gior. ital. d. mel. ven., 
Milano, 1908, xliii, 546-559. 

Panella, A. — Sulla flebite sifllitica 
secondaria — Gior. ital. d. mal. 
ven.. Milano, 1908, xliii, 684- 
702. 

Panse, R. — Zwolf schlafenbeine sie- 
ben falle van congenitaler lues 
— Arch. f. Ohrenh., Leipz., 1906, 
Ixviii. 31-43. 

Panto, V. — Due sedi rare di sifilonii 
primari — Gazz. internaz. di 
med., Napoli, 1908, xi, 260. 

Papadopoulo — Enorme hypertrophic 
congenitale des deux reins chez 
un foetus ne d'une mere syph- 
ilitique — Lyon med., 1907, cviii, 
834. 

Papee, J. — Die syphilis unter den 
prostitutierten in Lemberg — 
Arch. f. Dermat. u. Svph., Wien 
u. Leipz., 1908. lxxx'ix, 93-112. 

Papee. J. — Papulo-erosive syphilids 
zehn und dreizehn jahre nach 
der infektion — Monatsch. f. 
prakt. Dermat.. Hamb., 1909, 
xlviii, 347-352. 

Papee. J. — Non-sexual syphilitic in- 
fection — Przegl. lek., Krakow, 
1909, xlviii. 559. 569, 581, 593, 
600, 618. 

Papillon, P. H. — Syphilis acquise 
chez un enfant de deux ans os- 
teoperiostites precoces — Bull. 
Soc. de pediat., Paris, 1908. x, 
109-111. 

Papin — Recherches recentes sur la 
pathogenie de la syphilis — Arch, 
med. d'Angers, 1905. ix. 491. 

Parkinson. P. H. — Some late effects 
of inherited syphilis — Brit. J. 
Child. Dis.. Lond., 1908, v, 87- 
90. 

Parkinson, J. P. — A case of inher- 
ited syphilis, with infantilism, 
bone joint and visceral lesions — 
Rep. ' Soc. Study Dis. Child., 
Lond., 1908. viii, 255-258. 

Parodi, U. — Sulla presenza dello 
spirochete Schaudinn nel testi- 
colo in un casi di sifllide eredi- 
taria — Gior. d. r. Accad. di med. 
di Torino, 1906, 4 s. xii, 115. 



Parodi, U. — Ueber die uebertragung 
der syphilis auf den hoden des 
kaninchens — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1907, xliv, 
Orig. 428. 

Parodi, U. — Sulla transmissione 
della sifllide al testicolo del con- 
iglio — Gior. d. r. Acad, di med. 
di Torino, 1907, 4 s. xiii, 288. 

Papegaey — De la multiplicite du 
chancre syphilitique — J. de med. 
de Paris. 1905, 2 s. xvii, 593. 

Pardoe. J. — Svphilitic testicle — 
Polyclin.. Lond., 1905, ix, 121. 

Paris, A. et Debrovici, A. — Glyco- 
surie alimentaire et syphilis 
secondaire — Presse med., Paris, 
1905, 731. 

Parlato, R. — Due casi di fageden- 
ismo terziario nelle regioni gen- 
ital) con straordinarie deforma- 
zioni delle parti per stati ele- 
fantiastici consecutivi — Gior. 
internaz. d. sc. med., Napoli, 
1905, ns. xxvii. 145-152. 

Parvu, M. — Le sern -diagnostic de la 
svphilis — Tribune med., Paris, 
1908. 2 s. xl, 566-568. 

De Pascalis, G. — Spirochete pallida 
e diagnosi dell' infezione sifllit- 
ica— Policlin., Roma, 1905, xii, 
sez prat.. 861-866. 

Pasini. A. — Sulla presenza della spi- 
rochete pallida in alcune secre- 
zioni fisiologiche degli individui 
eredosifilitici — Oior. ital. d. mal 
ven., Milano. 1906. xii, 525. 

Pasini. A. — Lo stato attuale degli 
studi sperimentali sulla sifllide 
— Gior. ital. d. mal. ven., Mi- 
lano. 1907. xlii, 141-163. 

Pasini. A. — Lo stato attuale degli 
studi sperimentale sulla sifllide 
— Tribuna san.. Milano, 1907, 
1. 135. 171. 

Pasini. A. — Dimonstrazione della 
spiricheta pallida nei germi 
dentali de uno eredosifilitico — 
Gior. ital. d. mal. ven.. Milano, 
1908. xliii. 538-545, 1 pi. 

Pasini, A. — L'atossile (atoxy suo 
impiego nella cura della sifllide 
— Corriere san., Milano, 1908, 
xix, 290-311. 

Pasini, A. — Ricerche comparative 
fra i diversi metodi di siero- 
diagnosi proposito per la sifllide 
e considerazioni di sifilologia — 
Osp. magg. Riv-scient. prat, di 
Milano, 1909, iv, 170, 202. 



Recent Bibliography. 



373 



Pasini, A. — Sulla etiologia della sifi- 
lide — Gior. ital. d. mal. ven., 
Milano, 1905, xl, 317-385. 

Pasini, A. — A proposito delle recenti 
osservazioni sui protozoi nella 
sifilide — Gior. ital. d. mel. ven., 
Milano, 1905, xl, 355. 

Pasounagian, M. B. — Orchitis et 
epididymitis bilateralis syph- 
ilitica with gummata cutus — J. 
Cutan. Dis. incl. Syph., N. Y., 
1909, xxvii, 185. 

Paton, E. P. — A case of syphilitic 
periositis ■ — Polyclin., Lond., 
1907, xi, 96. 

Patterson, F. D. — Extra-genital 
chancre infection from a barber 
— Therap. Gaz., Detroit, 1905, 3 
s. xxi, 740. 

Pautrier, L. M. — Importance de 
l'examen de la bouche dans les 
cas de syphilis douteuse — Presse 
med., Paris, 1907, xv, 28. 

Pavloff, P. A. — Reinfectio syphilit- 
ica — Med. Obozr., Mosk., 1908, 
lxx, 731-734. 

Pavloff, P. A. — Consecutive giant 
and multiple hard chancres of 
the abdomen — Russk. j kozhn. 
i. ven. boliezn, Kharkov, 1909, 
xviii, 60-65, 1 pi. 

Payenneville — Un cas de syphilis 
hereditaire tardive — Norman- 
die med., Rouen, 1906, xxi, 547. 

Pebart, B. G. — Drei falle von syph- 
ilitischen fever — Russ. med.. 
Rundschau, Berl., 1906, iv, 261- 
276. 

Pechin — Osteo-periostite heredo- 
svphilitique orbitaire — Rec. 
d'ophth., Paris, 1906, 3 s. 
xxviii, 235. 

Pedersen, J. — Notes bearing on the 
value of the Wassermann test — 
Post-Graduate, N. Y., 1909, 
xxiv, 679-681. 

Pedersen, V. C. — Instructions to 
those having syphilis — Med. 
Rec, N. Y„ 1907, lxxii, 395-397. 

Pedersen, V. C. — Syphilitic manifes- 
tations in the oral cavity 
prophylaxis and a plea for the 
study of the disease by dental 
students — Dental Cosmos, 
Phila., 1908, 1, 327-334; Discus- 
sion 368-373. 

Peiser, J. — Zur prognose der hered- 
itaren lues — Therap. Monatsh., 
Berl., 1909, xxiii, 201-209. 



Pel, P. K. — Familiares vorkommen 
von akromegalie und myxodem 
auf luetischer grundlage — Berl. 
klin. Woch., 1905, xlii, Fest- 
Num. 25-28. 

Penichct y Gonzalez, T. — Un caso de 
rupia sifilitica — Rev. de med. y 
cirurg. de la Habana, 1909, xiv, 
293-299. 

Penne — Un cas de carreau d'origine 
syphilitique — Bull, et mem. soc. 
de med. de Vaucluse, Avignon, 
1909, v, 199-201. 

Peracehia, A. — Profilassi della sifi- 
lide — Rassegna san. di Roma, 
1908, vi, 2, 15. 

Pergola, M. — Dell 'azione della iodio- 
gelatina sui sangue dei sifilitici 
— Rev. crit. di clin. med., Fir- 
enze, 1905, vi, 313, 329, 345. 

Pergola, M. — Eicherche sui potere 
emolitico del siero di sangue di 
sifilitici e di individui sani e 
sulla resistenza delle relativo 
emazie a sieri eterogenei — Atti. 
d. r. Accad. d. fisiocrit in Siena, 
1905 4 s. xvii, 629-656. 

Pergola, M. — Sifiloma estragentali 
osservati nel dispensario e nella 
clinica dermosifilopatica di 
Siena dal 1884 al 1906— Atti. d. 
r. Accad. d. fisiocrit in Siena, 
1906, 4 s. xviii, 119-131. 

Perichitch — Notes sur la syphilis en 
Serbie — Soc. franc, de prophyl. 
san. et mor. Bull., Paris, 1905, 
v, 30-43. 

Perin, M. — Observations de syphilis 
transmisse por le rasoir — Soc. 
franc, de prophyl. san. et mor. 
Bull., Paris, 1905, v, 459-462. 

Peris. W. — Zur statistik der tertia- 
ren syphilis mit besonderer be- 
riicksichtigung der voraufgegan- 
genen behandlung — Arch. f. 
Dermat. u. Syph., Wien u. 
Leipz., 1907, lxxxviii, 77-98. 

Peritz, G. — Ueber das verhaltnis von 
lues tabes und paralyse zum 
lecithin — Ztschr. f. exper. path. 
u. therap., Berl., 1908-9, v, 607- 
621. 

Pernet, G. — Congenital syphilis — 
Brit. J. Child. Dis., Lond., 1908, 
v, 54-56. 

Pernet, G. — Extra-genital chancres 
— Clinical Journal, Lond., 
March 23, 1910. 



374 



Recent Bibliography. 



Pernet, G. — Inherited syphilis — 
Rep. Soc. Study Dis. Child.. 
Lond., 1908, viii, 74-78. 

Perot, H. — Etude sur la syphilis 
chez le medeein — Syphilis, 
Paris, 1905, iii, 196. 

Perrin. L. — Des chancres extra-genl- 
taux — Marseille med., 1905, xlii, 
734-736. 

Peteges — Chancre syphilitique hy- 
pertrophique au dos de la main 
gros reins Manes — J. de med. de 
Bordeaux. 1905, xxxv, 861. 

Petges, G. — La pathogenie et la 
prophylaxie de la syphilis 
d'apres les decouyertes experi- 
mentales recentes — Gaz. hebd. 
d. sc. med. de Bordeaux, 1907, 
xxviii. 13, 27, 37. 52. 

Peterson, O. — Uel>er die erfolgreiehe 
uebertragung der syphilis auf 
affen — St. Petersb. med. Woch., 

1906. xxxi. 203-205. 
Peterson, O. W. — Ueber die Metho- 

den der einfiihrung yon queck- 
silber in den organismus bei 
syphilis — Hu>s. med. Rundschau, 
Berl., 1906, iv. 5-12. 

Peterson. G. R. — Syphilis insontium 
— West. Canada M. J., Winni- 
peg, 1907, i, 353-359. 

Petit. G. et Minet, J.— A propos 
d'un cas d'heredo-syphilia foie 
silex anemie syphilitique. pres- 
ence de spirochetes dans le sang 
— Echo med. du nord, Lille, 

1907, xi. 255. 

Petit, G. et Minet. J. — Rapport sur 
un cas d'heredo-syphilis avec 
foie silex anemie syphilitique, 
presence de spirochetes dans le 
sang — Bull, et mem. Soc. med. 
d. hop., Paris, 1907, 3 s. xxiv. 
317. 

Petresco. G. Z. — Impregnation au 
nitrate d'argent des spirochete 
dans les coupes — Compt. rend. 
Soc. de biol., Paris, 1905, lix, 
680-682. 

Petzhold, E. — Multiple gummose 
lymphome — St. Petersb. med. 
Woch., 1908, xxv, 162. 

Pfender. C. A. — A review of recent 
observations on treponema pal- 
lidum of syphilis — Am. Med., 
Phila., 1906'. xi. 350-354. 

Phelan. H. du R. — The question of 
the origin of the lues venera 
among the eonquistadores in 
Mexico— J. Ass. Mil. Surg. U. S., 
Carlisle, Pa., 1906, xix, 237-242. 



Philaretopoulos, G. L. — A contribu- 
tion to the study of cutaneous 
syphilis — 
1908, viii, 2. 

Piccinini, G. — Le legge di Colles 
Policlin. Roma, 1905, xii, sez 
prat., 938-943. 

Piccinini. G. — Febbre sifllitica ter- 
ziaria contributo alio studio 
della febbre d'origine mascosta 
— Gazz. d. osp., Milano, 1908, 
xxix. 176-180. 

Pichevin, R. — Du chancre syphilit- 
ique du col uterin — Semaine 
gynec., Paris, 1907, xii, 209. 

Pick, L. u. Proskauer. A. — Die kom- 
plementbindung als hilfsmittel 
der anatomischen svphilisdiag- 
nose— Med. Klin., Berl., 1908, 
iv, 539-541. 

Pick, W. — Ueber einen spirochseten- 
befund bei einer framboesi for- 
men (tuberkulosen?) hauter- 
kriinkung — Arch. f. Dermat. u. 
Svph., Wien u. Leipz, 1907, 
lxxxv. 3-10, 1 pi. 

Picker. R. — Vegbelkanko ferfinal 
mint a hugyc-okanko szovod- 
menyeinek kovetkezmenye. ( Can- 
cer of the rectum in a male as 
a sequel of chancre of the 
urethra — Orvosi hetil, Budapest, 
1905. xlix, 874-898. 

Piorkowski — Ueber luesan — Allg. 
med. eentr-ztg., Berl., 1909, 
lxxxvii. 59. 

Le Pileur, L. — Les preservatifs de 
la syphilis a travers les ages — 
Ann. (1. mal. ven., Paris, 1907, 
ii. 501-527. 

Pinard. A. — Prophylaxie de 1'her- 
edo-svphilis — Rev. prat. d'ol>«t. 
et de paediat., Paris, 1905, 
xviii, 97-104. 

Pinard. A. — Rapport sur la preser- 
vation des nourices et des nour- 
issons contre la syphilis — Soc. 
franc, de prophyl. san. et mor. 
Bull., Paris. 1905, tome v, 202- 
223. 

Pinard, A. — Preservation des nour- 
rices et des nourrissons contre 
la syphilis — Soc. franc de 
prophvl. san. et mor. Bull., 
Paris. 1905. v, 286-330. 

Pinard, A. — Syphilis nourrices et 
nourrissons — Svphilis, Paris, 
1905, iii, 561-587. 

Pinard, A. — Prophylaxie de l'her- 
edo-syphilis — Ann. de gynec. et 
d'obst., Paris, 1905, 2 s." ii, 201. 



Recent Bibliography. 



375 



Pinard, A. — Preservation des nour- 
rices et des nourrissons contre 
la syphilis — Rev. prat, d'obst. 
et de pediat., Paris, 1905, xviii, 
129-151. 

Pineles, F. — Ueber die bedeutung 
der syphilis in der internen 
medizin — Wien klin. Rundschau, 
1905, xix, 849-868. 

Pinkus, F. — Ueber den jetzigen 
stand der syphilisforschung — ■ 
Beihfte. z. med. Klin., Berl., 
1907, iii, 207-236. 

Piorkowski — Weitere mitteilung 
ueber syphilisimpfung am pfer- 
de — Deutsche med. Woch., 
Leipz. u. Berl., 1905, xxxi, 910. 

Pismenny, N. N. — Syphilis in the 
factory population — Vestnik. 
obsh. hig. sudeb. i. prakt. med., 
St. Petersb., 1906, xlii, 1725- 
1736. 

Planer, H. P. — Ein fall von nieren- 
entziindung bei bestehender 
syphilitischer leberzirrhose mit 
thrombose der ganzen pfortader 
— Wien med. Presse, 1905, xlvi, 
1729. 

Plantier — Coma syphilitique — Bull. 
Soc. med-chir. de la Drome, Val- 
ence et Paris, 1905, tome vi, 
104. 

Plaut, F. — TJntersuchungen zur 
syphilis-diagnosis bei dementia 
paralytica und hies cerebri — 
Psychiat. u. neurol. Monatsehr., 
Berl., 1907, xxii, 95-145, 2 pi. 

Plaut, F,. Heuck, W. u. Rossi— Gibt 
es eine spezifisehe prazipitalreak- 
tion bei lues und paralyse? — 
Miinchen med. Woch., 19*08, lv, 
66-69. 

Plaut, F. — Serodiagnostik der syph- 
ilis — Zentralbl. f. Nervenh. u. 
Psychiat., Leipz., 1908, xxxi, 
289-295. 

Plazy, L. — Chancres syphilitiques 
multiples — Arch, de med. nav., 
Paris, 1906, Ixxxvi, 181-185. 

Ploeger, H. — Die spirochaten bei 
syphilis — Miinchen med. Woch., 

1905, lii, 1381. 

Polano — Lues hereditaria — Nederl. 
Tijdschr. v. Geneesk, Amst., 

1906, ii, 1136. 

Polland, R. — Der gegewartige stand 
unserer kenntnisse ueber die 
syphilis-aetiologie — Mitt. d. 
Ver. d. Aerzte in Steiermark, 
Graz., 1906, xliii, 161-166. 



Polland, R. — Spirochatenbefunde bei 
nosokomialgangran in unter 
schenkelgeschwiiren — Wien klin 
Woch., 1905, xviii, 1236-1239. 

Polland, R. — Ein fall von reinfek 
tion (superinfektion) bei syph 
ilis — Wien klin. Wchnschr. 
1908, xxi, 1705-1707. 

Polland, R. — Immunitat und sero 
diagnostik bei lues — Mitt, d 
Ver. d. aerzte in Steiermark 
Graz., 1909, xlvi, 33-41. 

Pollitzer, S. — The progress of syph 
ilis — Post Graduate, N. Y. 

1907, xxii, 601-616. 
Pollitzer, S. — Serum therapy and 

serum diagnosis in syphilis — N. 

York M. J., 1907, lxxxv, 976. 
Pollio, G. e Fontana, A. — Alcune 

ricerche sopra la sonsidetta 

reazione di Justus — Gazz. d. 

osp., Milano, 1905, xxvi, 5. 
Pollio, G. e Fontana, A. — Reperto 

della spirochete di Sehaudinn 

nell' acne sifilitica del capillizio 

— Gaz. d. osp., Milano, 1905, 

xxvi, 1143. 
Pollio, G. — La reazione di Schur- 

mann per la diagnosi della sifll- 

ide — Gaz. d. osp., Milano, 1909, 

xxx, 1245. 
Polozker, I. L. — Syphilis in infancy 

and childhood — Am. J. Dermat. 

and Genito-Urin. Dis., St. Louis, 

1908, xii, 463-466. 
Poltavtseff, A. P. — Extra-genital 

syphilitic infection — Russk. j. 
kozhn. i. ven boliezn, Kharkov, 

1905, x, 298-300. 
Poltavtseff, A. P. — Late hereditary 

syphilis — Russk. j. kozhn i ven 
boliezn, Kharkov, 1905, ix, 477. 
PotlavtsefT, A. P. — General syph- 
ilitic leoeoderma — Russk. j. 
kozhn i ven boliezn, Kharkov, 

1906, vi, 437. 

Poltavtseff, A. P. — Hereditary syph- 
ilis — Russk. j. kozhn i ven bol- 
iezn, Kharkov, 1906, vi, 439. 

Pommer — Zur kenntnis der heredi- 
taren schadelsyphilis — Ver- 
handl. d. deutsche. path. Ge- 
sellsch., 1905, Jena, 1906, 312- 
324, 1 pi. 

Ponti, G. D. — Emoglobinuria e sifi- 
lide — Scuola salernit, Salerno, 

1909, x, 1-6. 

Poor, F. — Ueber die linienformigen 
narben bei der hereditaren syph- 
ilis — Dermat. Ztschr., Berl., 
1905, xii, 207-215. 



376 



Recent Bibliography. 



Popoff, N. M. — Meningitis basilaris 
gummosa — Vrach Gazz., S. 
Petersb., 1006, xiii, 1037, 1057. 

Porges, 0. — Zur serodiagnostik der 
lues mittels ausflockung — Ver- 
handl. d. Kong. f. innere Med., 
Wiesb., 1908, xxv, 197-240. 

Porges, O. u. Meier, G. — Ueber die 
rolle der Iipoide bei der Was- 
sermanuschen syphilis-reaktion 
— Berl. Win, Woeh., 1908, xlv, 
731-730. 

Porosz, M. — Peculiar cases of syph- 
ilis — Gvogvaszat, Budapest, 
1907, xlvi, 628-630. 

Poroz, M. — Besondere syphilisfalle — 
Arch. f. Dermat. u. Syph., Wien 
u. Leipz., 1908. lxx.xix. 281-288. 

Del Portillo, L. — Causae que favor- 
ecen la propagacion de la sif- 
ilia — Rev. espan. de dermat. v 
Bif., Madrid, 1909. xi. 285-295. 

Del Portillo, L. — Dos palabras 
aeerca de la transmisibilidad de 
los accidentea sifilitieos terciar- 
ios — Rev. espan. de dermat. v 
sif., Madrid. 1909. xi. 331-333. " 

Del Portillo, L. — Estudio de las di- 
versaa modalidades del contagio 
indirecto de las sifilis — Rev. es- 
pan. <le dermat. V sif.. Madrid, 
1909. xi, 379-389.' 

Posey, W. C. — Triangular opacity in 
the superficial layers of the cor- 
nea, occurring in syphilitic sub- 
jects — Ophth. Ree.. Chicago. 
1906. xv, 47-50. 

Posey, W. C. and Krauss, F. — Re- 
port of three cases presenting 
ocular manifestations of ter- 
tiary syphilis in colored sub- 
jects — Ophthalmol., Milwaukee, 
1907-8, iv, 391-395. 1 col. pi. 

Post, A. — A case of syphilis in a 
. negro closely simulating a tu- 
berculide — J. Cutan. Dis. incl. 
Syph., X. Y., 1905, xxiii, 179. 

Post, A. — The length of the primary 
incubation stage of svphilis — 
J. Cutan. Dis. incl. Syph., N. 
Y., 1900. xx iv. 362-370. 

Post, A. — A case of papulo-pustular 
syphilide of varioliform char- 
acter — J. Cutan. Dis. incl. 
Syph.. X. Y.. 1907. xxv. 38. 

Postovski. X. P. — Diagnosis of 
syphilitic psychoses — J. nervo- 
pat. i. psikhiat.. Korsakova. 
Mosk., 1904, iv, 1023-1047. 



Potier, F. — Un cas de syphilis con- 
genitale avec lesions gommeuses 
multiples et degenerescence pig- 
mentaire par hematolyse — 
Arch, de med. Exper. et d'anat. 
path.. Paris, 1907, xix, 152-163, 
1 pi. 

Potter. X. B.— The value of Vir- 
chow's smooth atrophy of the 
base of the tongue in the diag- 
nosis of svphilis — Boston M. 
and S. J.. 1906, clix, 260-263, 
1 pi. 

Potijol, J. — Prophylaxie de la syph- 
ilis dans la commune mixte 
d'Ain-liessem (Alger) — Bull, 
med. de 1'Algier. Alger, 1905, 
xvi. 286. 

Poulard — Syphilis hereditaire tar- 
dive — Progres med.. Paris, 
1909. .') a. xxv, 525. 

Power, D. A. — A clinical lecture on 
heredo-syphilis — Med. Press and 
Circ. Eond., 1909, ns. lxxxv, 
110. 

Prausnitz, C. — Syphilis — J. Pre- 
vent. Med., Lond., 1900, xix, 
113-115. 

Preis, K. — Die methodik der unter- 
suehung auf spirochete pallida 
— Wien Med. Presse. 1900, 
xlvii, 2525. 

Preis, K. — A spirochaeta pallida 
mint diagnostikai segedeszkoz. 
(The ... as a diagnostic aid) 
— Orvosi hetil, Budapest, 1906; 
1, 242. 

Preis, K. — The bacteriological di- 
agnosis of syphilis — Budapest 
orv ujsa.L'. 1907. v, 739-746. 

Preis. K. — Ueber den practiscben 
bei syphilis — Pest. med. chir. 
Presse, Budapest. 1908, xliv, 
1085-1089. 

Preiser, G. — Knochengummata — 
Deutsche med. Wchnschr., 
Eeipz. u. Berl., 1907, xxiii, 
1197. 

Preiser, G. — Ueber knochenveran- 
derungen bei lues congenita 
tarda — Fortschr. a. d. Geb. d. 
Rontgenstrahlen, Hamb., 1908, 
xii, 81-88. 

Preiser, G. — Luetische X-Beine — 
Deutsche med. Woeh., Leipz. u. 
Berl., 1908, xxxiv. 132. 

Price. E. T. — The initial lesion of 
svphilis — Old Dominion J. M. 
and S.. Richmond. 1908, vi, 
589-591. 






Recent Bibliography. 



377 



Priesmyakoff — Chancre of the right 
thumb — Med. pribav k niorak 
sborniku, St. Petersb, 1905, 
143. 

Priklonski, I. I. — Syphilitic sclero- 
sis and papulopustules syph- 
ilide in a patient suffering for 
many years from gumma on 
the foot — Russk. j. kozhn. i. 
ven. boliszn, Kharkov, 1909, 
xviii, 66-71. 

Proca, G. et Vasilescu, V. — Sur un 
procecle de coloration rapide du 
spirochete pallida — Compt. 
rend. Sic. de biol., Paris, 1905, 
lviii, 1044.. 

Prowazek, S. — Technik der spiro- 
chate-untersuchung — Ztschr. f. 
Wissensch. Mikr., Leipz., 1906, 
xxiii, 1-12. 

Prowazek, S. — Morphologische und 
entwicklungsgeschichtliche un- 
tersuchungen ueber hiihnerspi- 
roeheten — Arb. a. d. k. Gsnd- 
htsamte, Berl., 1906, xxiii, 554- 
565. 

Prowazek, S. — Bemerkungen zur 
spiroclieten und vaccinefragen 
— Centralbl. f. Bacteriol., 1 
Abt., Jena, 1908, xlvi, Orig. 
229-231. 

Puccioni — Sulla presenza della spi- 
rochseta pallida (o treponema 
pallidum o spironema) nell' 
umore acqueo nella sifilide ocu- 
lare — Bull. d. osp. oftal. d. 
prov. di Roma, 1907, v, 163- 
167. 

Puchovski, A. M. — Chancre of the 
mouth — Voyenne-med. J., St. 
Petersb., 1907, cxviii, med- 
spec. pt. 686-691. 

Pusateri, S. — Ueber prima affekte 
am hasenseptum gammelreferat 
— Internat. Centralbl. f. 
Ohrenh., Leipz., 1907, v, 461- 
464. 

Puterman, J. — Spirochete pallida — 
Czaso-pismo lek, Lodz, 1906, 
viii, 215-222. 



Quarelli, G. — Azione delle iniezioni 
di lecitina sulla reazione di 
Wassermann — Raasegna di 
terap., Roma, 1909, xxvii. 993- 
997. 



De Queniros, Mattosso F.- — Sobre 
tun caso interessante e pouco 
eommun de syphilis hereditaria 
— Rev. med. 'd. S. Paulo, 1905, 
viii, 157-162. 

De Queriros, Mattosso F. — Un cas 
peu eommun de syphilis hered- 
itaire — Rev. mens. d. mal de 
1'enf., Paris, 1905, xxiii, 466-473. 

Query, L. C. — La micro-organisme 
de la syphilis inoculations ex- 
perimentales — Bull. d. sc. Phar- 
macol., Paris, 1905, xii, 127- 
139, 4 pi. 

Query, L. C. — Syphilis et mercure — 
Compt. rend. Soc. de biol., 
Paris, 1906, lx, 177-179. 

Query, L. C. — Le micro-organisme 
de la syphilis — Compt. rend. 
Soc. de biol., Paris, 1907, lii, 
379. 

Queyrat — De 1'auto inoculabilite du 
chancre syphilitique — Bull, et 
mem. Soc. med. d. hop. de Paris, 
1905, 3 s. xxii, 8. 

Queyrat et Joltrain — Recherche du 
spirochete de Schaudinn dans 
les chancres syphilitiques — - 
Bull, et mem. Soc. med. d. hop., 
Paris, 1905, 3 s. xxii, 559. 

Queyrat, Levaditi et Feuillie — Con- 
statation du spirochete de 
Schaudinn dans le foie et la 
rate d'un foetus macere — Bull. 
Soc. franc, de dermat. et syph., 
Paris, 1905, xvi, 317-319. 

Queyrat — Le chancre syphilitique et 
ses varietes — J. de med. int., 
Paris, 1906, x, 204-207. 

Queyrat — Auto-inoculation de chan- 
cre syphilitique — Bull. Soc. 
franc, de dermat. et svph., 
Paris, 1906, xvii, 66-70, 1 pi. 

Queyrat — Auto-inoculation de chan- 
cres syphilitiques — Bull. Soc. 
franc, de dermat. et syph., 
Paris, 1906, xvii, 172-183. 

Queyrat et Boisseau — Sur le cas de 
boubo presente, par M. Hallo- 
peau — Bull. Soc. franc, de der- 
mat. et syph., Paris, 1905, xvi, 
272-280. 

Queyrat, L. et Levaditi — Recherche 
du treponema pallidum ( spiro- 
chete) de Schaudinn dans les 
coupes de lesions syphilitiques 
primaires, secondaires et ter- 
tiaires — Bull, et mem. Soc. 
med. d. hop. de Paris, 1906, 3 
s. xxiii, 321-327. 



378 



Recent Bibliography. 



Queyrat, L. — Nouveau cas d'auto- 
inooulation de chancre sypbilit- 
ique — Bull, et mem. Soc. d. 
hop., Paris, 39. xxiii, 1221. 
Queyrat, L. — Dix-septieme cas 
d'auto-inoeulation positive de 
chancre syphilitique — Bull, et 
mem. Soc. med. d. hop., Paris, 
1907, 3 s. xxiv, 207. 
Queyrat, L. — Syphilis et mariage; 
dystrophies multiples chez un 
enfant ne d'un pere syphilit- 
ique; non traite dix ans apres 
l'accident initial — Pediatrie 
prat., Lille, 1907, v, 191. 
Queyrat — Le chancre simple — Med. 

mod., Paris, 1908, xix, 306. 
Queyrat et Pinard — Resultats de 
l'inoculation des produits syph- 
ilitiques primaires aux sujets 
atteints d'accidents tertiaires — 
Bull. Soc. franc, de dermat. et 
syph., Paris. 1909, xx, 156-159, 
1 pi. 
Queyrat. L. — La syphilis dite 
maligne precoce est-elle de la 
syphilis? — Bull, et mem. soc. 
nied. d. hop. de Paris, 1908, 3 
s. xxv, 147-151. 
Queyrat. L. et Bricout — Chancrelle 
de l'index — Bull, et mem. Soc. 
med. d. hop. de Paris, 1908, 3 
s. xxv, 1002-1004. 
Queyrat. L. et Pinard, M. — Chancre 
simple de la levre (constatation 
du bacille de Ducrey inoculation 
positive) — Bull, et mem. soc. 
med. d. hop. de Paris, 1909, 3s. 
xxvi, 370-372. 
Queyrat, L. — La syphilis dite 
maligne precoce est-elle de la 
syphilis? — Rev. internat. de med. 
et de chir., Paris, 1908, xix, 421. 
Queyrat — Le treponeme dans la 
syphilis caracteres; recherche 
technique bacteriologique — lied, 
mod.. Paris, 1908, xix, 282. 
Quillan, D. D. — Racial peculiarities 
a cause of the prevalence of 
syphilis in negroes — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1906, x, 277-279. 
Quimby. W. C. — The demonstration 
of the spirochscta pallida by the 
method of dark field illumina- 
tion — Boston, M. and S. J., 
1908, clix, 175. 
Quinn, W. A. — Case of syphilis with 
ankylosis of the mandible — J. 
Cutan. Dis. incl. Syph., N. Y., 
1907, xxv, 276. 



Rach, E. u. Wiesner, R.- — Weitere 
mitteilungen ueber die erkriink- 
ung der grossen gefiisse bei 
kongenitaler lues — Wien klin. 
Woch.. 1907, xx, 521. 
Radaeli, F. — Richerche sulla spiro- 
cheta pallida della sifilide ac- 
quista ed ereditaria — Gior. ital. 
d. mal. ven., Milano, 1906, xlvi, 
151-166. 
Radaeli, F. — Dimostrazione della 
spirocheta pallida nella pla- 
centa — Sperimentale Arch, di 
biol.. Firenze, 1906, lx, 397-400, 
1 P l. 
Radaeli, F. — Sullo stato attuale 
della noste conoscenze interno 
alia eziologi a della sifilide — 
Clin, med., Firenze, 1907, xiii, 
430-435. 
Radziminski — Several cases of syph- 
ilitic re-infection — Med. prib k 
morsk sborniku, St. Petersb., 
1906, 139. 
Rajat — Chancres multiples de la 
verge — Centre med. et pharm., 
Gannat, 1907-8, xiii, 202. 
Rajat — Chancres extra-genitaux — 
Centre med. et pharm., Gannat, 
1907-8, xiii, 235. 
Rajat — Le sero-diagnostic de la 
syphilis — Centre med. et 
pharm., Gannat, 1908-9, xiv, 
36-39. 
Rajchman, L. and Szymanowski, Z. 
— Practical notes on Wasser- 
mann test — Przegl. lek., Kra- 
kow, 1909, xlviii, 387. 
Ramazzotti, V. — Sulla spirochete 
pallida di Schaudinn ed Hoff- 
mann — Osp. magg. Riv-scient. 
prat, di Milano, 1907, ii, 25-34. 
Ramognini, P. — Contributo alio 
studio dei sifilomi iniziali della 
pituitaria — Gior. ital. d. mal. 
ven., Milano, 1907, xiii, 287- 
300. 
Ranke, O. — Ueber gehirnverander- 
ungen bei der angeborenen syph- 
ilis — Ztschr. f. d. Erforsch. u. 
Behandl. d. jugendi Schwach- 
sinns, Jena, 1908, ii, 32-56. 
Ranke, O. — Ueber gehirnverander- 
ungen bei der angeborenen syph- 
ilis — Ztschr. f. d. Erforsch. u. 
Behandl. d. Jugendi. Schwach- 
sinns, Jena, 1908, ii, 81, 211. 



Recent Bibliography. 



379 



Rapiport, L. R. — Ulcus induratum 
digiti secundi — Vrach Gaz., S. 
Petersb., 1907, xiv, 387. 

Raubilschek, H. — Ueber einen fund 
von spirochete pallida im krei- 
senden blut — Wien klin. Woch., 
1905, xviii, 752. 

Raubitsehek, H. — Zur kenntniss der 
fieberhaften tertiar-syphiliti- 
schen organerkrankungen — 
Centralbl. f. d. Grenzgeb. d. 
Med. u. Chir., Jena, 1906, ix, 
641-650. 

Rauschburg, P. — Oroklott bujakoros 
alapon fejlodott gyer mekdedseg 
( infantilismus ) esete. ( Infan- 
tilism developing on a congeni- 
tal syphilitic foundation) — 
Gyermekorvos, Budapest, 1906, 
1-7. 

Eavaut, P. et Ponselle, A. — 
Eecherches sur la presence du 
spiroehsete pallida dans le sang 
des syphilitiques — Gaz. d. hop., 
Paris, 1906, lxxix, 1023. 

Eavaut, P. et Ponselle, A. — Contri- 
bution a 1'etude clinique et bac- 
teriologiche des lesions enceph- 
alomeningees chez les nouveau- 
nes syphilitiques — Bull. et 
mem. Soc. med. d. hop de 
Paris, 1906, 3 s. xxiii, 3-7. 

Eavaut, P. — Le liquide cephalo- 
rachidien des heredo-syphilit- 
iques — Ann. de dermat. et 
syph., Paris, 1907, 4 s. viii, 81- 
112. 

Eavaut, P. et Darre — Etude des re- 
actions meningees dans un cas 
de syphilis hereditaire — Gaz. d. 
hop., Paris, 1907, lxxx, 207. 

Eavaut, P. et Ponselle, A. — 
Eecherches sur la presence du 
spirochete pallida dans le sys- 
tenie nerveux de l'homme au 
cours de la syphilis aequise et 
hereditaire — Bull, et mem. 
Soc. med. d. hop. de Paris, 1907, 
3 s. xxiv, 1462-1473. 

Eavaut, P. et Ponselle, A. — Impreg- 
nation du spirochete pallida 
dans les frottis sur l'ames au 
moyen de la largine (albumin- 
ate d'argent) — Compt. rend, 
soc. de biol., Paris, 1908, lxv, 
438-440. 

Eavaut. P. — Le liquide cephalo- 
rachidien au cours de la syph- 
ilis aequise et hereditaire — 
Eev. mens, de med. int. et de 
therap., Paris, 1909, i, 257-273. 



Ravogli, A. — Considerations on in- 
herited syphilis, with special 
reference to paternal inherit- 
ance — Lancet-Clinic, Cincin., 
1905, ns. liv, 593. 

Eavogli, A. — Influence of paternal 
inheritance on hereditary syph- 
ilis — Am. J. Dermat. and Gen- 
329. 
Ur. Dis., St. Louis, 1905, ix, 

Eavogli, A. — Syphilis in relation to 
crime — Ohio M. J., Columbus, 
1906-7, ii, 68-74. 

Eavogli, A. — Elephantiasis of the 
penis and scrotum due to syph- 
ilis — J. Cutan. Dis. incl. Syph., 
N. Y., 1907, xxv, 61. 

Eavogli, A. — Syphilis in relation to 
crime — J. Cutan. Dis. incl, 
Syph., N. Y., 1907, xxv, 82. 

Eavogli, A. — The relation of the 
character of the syphilitic 
initial lesion to the secondary 
constitutional period — J. Am. 
M. Ass., Chicago, 1908, li, 2031- 
2034. 

Eavogli, A. — Syphilis of the face — 
Lancet-Clinic, Cincin., 1909, ci, 
564-566. 

Raymond, E. et Touchard, P. — 
Meningite heredo-syphilitique a 
forma tabetique — Eev. neurol., 
Paris, 1909, xvii, 492-496. 

Reckzeh, P. — Ueber protoplasmati- 
sche korperchen in den lymph- 
drusen syphilitischer ■ — Ztsehr. 
f. exper. path. u. therap., 
Berl., 1905-6, ii, 649-654, 1 pi. 

Redard, C. — De la dent d'Hutchison 
— Rev. trimest. Suisse d'odont., 
Zurich et Geneve, 1906, xvi, 
261-274. 

Redon, B. M. — Transmission heredo- 
sifilitica — Rev. espan. de der- 
mat. y sil, Madrid, 1908, x, 
489-493. 

Reiche, A. — Ueber den diagnosti- 
schen wert tastbarer cubital- 
drusen bei sauglingen — Monat- 
schr. f. Kinderh., Leipz. u. 
Wien, 1908, vi, 511-517. 

Reinach, O. — Beitrage zur Rontgen- 
oscopie von knochenaffectionen 
hereditar luetischer sauglinge — 
Arch. f. Kinderh., Stuttg., 1906- 
7, xlv, 1-20. 

Reinhart, A. — Erfiihrungen mit der 
Wassermann-Neisser-Bruckschen 
syphilis reaktion — Miinchen 
med. Woch., 1909, lvi, 2092- 
2097. 



380 



Recent Bibliography. 



Reischauer — Ein weiterer spirochat- 
enbefund bei hereditar lues — 
Deutsche med. Woch.. Leipz. u. 
Berl.. xxxi. 1350. 

Reissenhach — Yeranderungen an 
ziihnen mid kiefern dureh syph- 
ilis uud rhachitis — Deutsche 
zahniirztl. Ztg.. Miinchen, 1905, 
iv, 4. 

Reitmann, K. — Zur farbung der spi- 
rochete pallida Schaudinn — 
Deutsche med. Woeh.. Leipz. u. 
Berl.. 190S, xxxi. 997. 

Remijnsp. J. G. — Keen geval van 
dactylitis syphilitica — Xederl. 
Tijdschr. v. Oeneesk. Amst.. 
1907. ii. 1406-1410. 1 pi. 

Renault, A. — Syphilide tertiaire 
d'aspecl anomal — Bull, et mem. 
Soc. med. d. hop. de Paris. 
1906, 3 s. xxiii. 26-29. 

Renault. A. — Diagnostic du chancre 
syphilitique balano-preputial — 
Rev. intermit, de med. et de 
chir.. Pari-. 1907, sviii, -223-225. 

Renault. A. — Chancre syphilitique 
de la voitc palatine — Bull. Soc. 
franc, de dermat. et svph., 
Paris. 1907. xviii. 300. 

Renault. A. — La roseole syphilitique 
— Rev. gen. de clin. et de 
therap., Pari-. 1907, xxi. 305. 

Renault. A. — Chancre syphilitique 
et chancre mou — J. de med. int., 
Paris. 1907. xi. 340. 

Renault. A. — Accidents secondaires 
prolonges ou reinfection syph- 
ilitique — Bull. Soc. franc, de 
dermat. et syph., Paris. 1908. 
xix. 222-225. 

Renault. A. — Cicatrices hypertro- 
phiques consecutives a une syph- 
ilide papuleuse — Bull. Soc. 
franc, de dermat. et svph., 
Paris. 190S. xix, 234. 

Renault. A. et Salmon. P. — Psori- 
asis et syphilis: valeur diag- 
nostique du treponema — Bull. 
Soc. franc, de dermat. u. syph., 
Paris. 1908. xix. 319 -321. ' 

Renault. A. — Syphilide lichenoide et 
cicatrices hypertrophiques con- 
secutives a une syphilide pap- 
uleuse — Bull, et mem. Soc. med. 
d. hop de Paris, 1908. 3 s. xxv. 
1014-1018. 

Renault. A. — Syphilide psoriasi- 
forme sclerose linguale syphilit- 
ique tardive syphilis et blen- 
orrhagie prurigo ethyl ique — 
Med. mod.. Paris, 1908, xix, 225. 



Renault, A. — Lupus erythemateux 
ou syphilis lipoide — Bull. Soc. 
franc, de dermat. et svph., 
Paris., 1908, xix, 221. 

Renault, A. — Des syphilides gom- 
meuses ulceratives — Rev. gen. 
de clin. et de therap., Paris, 
1908. xxi, 449-452. 

Renault. A. — Frequence et prophy- 
laxis de la syphilis — Rev. 
d'hvg.. Paris, 1908, xxx, 165- 
183. 

Renault, A. — Des priucipales syph- 
ilides secondaires de la peau — 
Clinique. Paris. 1908, iii. 818- 
822. 

Renault. A. — Cicatrices hypertro- 
phiques :1 la suite d'une syphilide 
papuleuse ancienne — Bull. Soc 
franc, de dermat. et svph., 
Pari-. 1909, xx. 145. 

Renault. A. — Un nouvel exemple de 
cette forme de syphilis cerebro- 
medullaire appelee syndrome de 
Guillain Thaon — Bull. Soc. 
franc, de dermat. et svph., 
Paris. 1909. xx. 149-151. 

Renault. A. — Vastes syphilides ul- 
cereuses precoces et plaques ery- 
themateuses concomitante- — 
Bull. Soc. franc, de dermat. et 
syph., Paris, 1909. xx, 154. 

Renault, A. et Guenot — Un enorme 
chancre du menton an rasoir 
— Bull. Soc. franc, de dermat. et 
syph., Paris, 1909. xx, 144. 

Renaux — 1 lieorje et demonstration 
de la reaction de Wassermann — 
Presse med. beige, Brux., 1909, 
lxi. 61-66. 

Renon. L. — Retrecissement mitral 
aortite coronarite et tabes chez 
une syphilitique — Arch. gen. de 
med.. Pari-. 1905. tome i. 853. 

Respighi. E. — Ittiosi ed eredosifilide 
— Scuola salernit, Salerno, 
1906, vii. 100-105. 

Renter. K. — Neue hefunde von spi- 
rochete pallida (Schaudinn) im 
menschlichen korper und ihre 
bedeutung fiir die aetiologie der 
syphilis — Ztschr. f. Hyg. u. In- 
fektionskrankh., Leipz., 1906, 
liv, 49-64, 2 pi. 

Rey, A. — Un cas de gangrene syph- 
ilitique — Bull. med. de l'Algerie, 
Alger. 1905. xvi. 500. 

Reyher — Ueber knochenverander- 
ungen bei hereditarer spvhilis — 
Berl. klin. Woch., 1908, xlv, 
1423. 



Recent Bibliography. 



381 



Reyher — Ueber die knoehenverand- 
erungen bei hereditarer syphilis 
— Verhandl. d. deutsch. Rontg. 
Gesellsch., Hamb., 1908, iv, 115- 
119. 

Rheimer, G. — Klinishoer beitrag zur 
lues hereditaria infantilis — Cor- 
Bl. f. schweiz. Aerzte, Basel, 

1905. xxxv, 671-680. 
Ribadeau-Dumas et de Jong — 

Plaques muqueses de la langue 
d'un heredo-syphilitique ; re- 
cherche des spirochetes pales 
par la methode de Levaditi — 
Bull, et mem. Soc. anat. de 
Paris, 1906, lxxxi, 630. 

Ribadeau-Dumas, L. et Poisot — 
Ictere et hemorrhagies chez un 
heredo-syphilitiques anemie et 
myelemie septicemic a spiro- 
chete pallida — Compt. rend. 
Soc. de biol., Paris, 1907, Ixii, 
247. 

Ribadeau-Dumas, L. — Reactions 
hematopoietiques du foie her- 
edo-syphilitique — J. de physiol. 
et de path, gen., Paris. 1908, x, 
682-692, 1 pi. 

Ribadeau-Dumas, L. et Camus, P. — 
Osteo-arthrites purulentes et 
heredo-syphilis du nourrisson — ■ 
Bull. Soc. de pediat., Paris, 
1908, x, 223-226. 

Ribadeau-Dumas, L. et Camus, P. — 
Osteo-arthrites purulentes et 
herero-syphilis du nourrisson — 
Ann. de med. et chir. inf., Paris, 
1908, xii, 672-675. 

Ricca-Barberis, E. — Reperto emato- 
logico in un caso di sifllide — 
Gazz. med. ital., Torino, 1908, 
lix, 171. 

Richards, G. M. O. and Hunt, L — 
A note on the occurrence of a 
spirillum in the blood of pa- 
tients suffering from secondary 
syphilis — Lancet, Lond., 1905, 
ii, 962. 

Richards, G. M. 0. — The diagnostic 
value of the spirochseta pallida 
in venereal sore, illustrated by 
a number of cases — Med. 
Chron., Manchester, 1905-6, 
xliii, 273-291. 

Richards, G. M. O. and Hunt, L. — 
The spirochetal found in syph- 
ilitic lesions — Lancet, Lond., 

1906, i, 667. 

Ricbon et Lucien — Gomme syphilit- 
ique volumineuse du foie comme 



manifestation isolee chez une 

femme morte de scarlatine — 

Rev. med. de l'oust, Nancy, 1908, 

xi, 688. 
Riecke — Ueber einen befund von spi- 

rochsete pallida bei syphilis — 

Deutsche med. Woch., Leipz. u. 

Berk, 1907, xxxiii, 287. 
Rickenbach — Kopfschmerzen und 

syphilis — Med. Klin., Berk, 

1909-10, v, 1551. 
Riegel — Zwei hereditar-syphilitische 

geschwister mit interessantem 

augenbefund — Miinchen med. 

Woch., 1907, liv, 546. 
Rietschel, H. — Ueber den infektions- 

modus bei der konigenitalen 

syphilis — Med. Klin., Berk, 

1909, v, 658-663. 
Rille — Ueber spirochatenbefunde bei 

syphilis — Miinchen med. Woch., 

1905, lii. 1377, 1 pi. 

Rille u. Vockerodt, A. — Weitere spi- 
rochsetabefund bei syphilis — • 
Miinchen med. Woch.. 1905, lii, 
1620. 

Rille — Eine frau mit tertiarer syph- 
ilis und jododerma tuberosum — 
Miinchen med. Woch., 1906, liii, 
2273. 

Rille — Eine 27-jahrige frau mit 
syphilis ulcerosa der gesichts- 
haut — Miinchen med. Woch., 

1906, liii, 2274. 

Rimbaud et Reveille — Phlebite 
syphilitique du membre super- 
ieur — Montpel. med., 1909, 
xxviii, 63-67. 

Bipoll, G. — Heredo-sifllis lesiones 
epifisarias congenitas con an- 
quilosis por sifilis materna con- 
traida con la lactaneia de un 
nino sifllitico — Med. de los 
ninos, Barcek, 1908, ix, 171. 

Risel, H. — Blutveranderungen bei 
jungen hereditar luetischen 
siiuglingen — Verhandl. d. ver- 
sanrml. d. Gesellsch. f. kinderh. 
deutsch. naturf u. aerzte, 1908, 
Wiesb., 1909, xxv, 66-76. 

Risel, H. — Blutbefunde bei jungen 
hereditarluetischen siiuglingen 
— Verhandl. d. Gesellsch. 
deutsch. naturf. u. aerzte, 
Leipz., 1909, 2 teil, 2 hfte., 318. 

Risso, A. e Cipollina, A. — Sulla pre- 
senza dello spirochsta Schaud- 
inn-Hoffmann nelle glandole in- 
guinali dei sifilitici secondarie 
— Riforma med., Palermo-Na- 
poli, 1905, xxi, 848. 



382 



Recent Bibliography. 



Risso, A. e Cipollina, A. — Spiro- 
chseta pallida e infezione sifil- 
itica — Riforma med., Palermo- 
Napoli, 1905, xxi, 938. 

Risso, Dominquez J. C. — La inves- 
tigacion en obstetricia del spi- 
rochete pallida de Schaudinn 
— Semana med., Buenos Aires, 

1906, xiii, 493-497. 

Rispal — Recherche du treponeme 
pale de Schaudinn dans les or- 
ganes internes au cours d'une 
syphilis secondaire — Arch. med. 
de Toulouse, 1907, xiv, 49. 

Ritter, E. — Beitrage zum nachweis 
der spirochete pallida in syph- 
ilitischen produkten — Miinchen 
med. Woch., 1906, liii, 2004. 

Robbins, H. A.— Syphilis of the or- 
gans of the sight and hearing 
and taste and sense of smell and 
the teeth and accessory organs 
of digestion — Am. J. Dermat. 
and Genito-Urin. Dis., St. Louis, 
1908, xii, 324-331. 

Robbins, H. A. — Syphilis of the 
vital organs — Am. J. Dermat. 
and Genito-Urin. Dis., St. 
Louis, 1907, xi, 73-108. 

Robbins, H. A. — The varioliform 
syphiloderm— Am. J. Dermat. 
and Genito-Urin. Dis., St. Louis, 

1907, xi, 330. 

Robin, A. — Syphilis in a woman 
who handles mercury constant- 
ly in her daily work — Internat. 
Clin., Phila., ' 1905, 15s. 1, 15- 
18. 

Robinson, Daisy O. — A case of syph- 
ilis — J. Cutan. Dis. inel. Svph., 
N. Y., 1908, xxvi, 38. 

Robinson, H. B. — A case of exten- 
sive adhesions in pharynx and 
larynx of syphilitic origin — 
Proc. Roy. Soc. Med., Lond., 
1907-8; i' Laryngol. Sect. 67. 

Robinson. J. A. — The duration and 
possible curability of syphilis 
— Am. J. Dermat. and Genito- 
Urin. Dis., St. Louis, 1906, x, 
379. 

Robledo. E. — Deux cas de pian en 
Colombie — Bull. Soc. path, 
exot., 1909, ii, 245-247. 

Roblin — Etude clinique des plaques 
muqueuses — Gaz. med. de Paris, 
190S, No. 25, 5. 

Roca, E. — La sifilis y el trauma- 
tismo — An. san. mil., Buenos 
Aires, 1905, vii, 131-155. 



Roche, C. — Chancre indure de la 
paupiere — Marseille med., 1908, 
xlv, 482. 

Roche, C. — Chancre indure de la 
conjunctive — Marseille med., 
1908, xlv, 585-587. 

Rodier, H. — Chancre syphilitique 
nevrogene de la levre super- 
ieure avec elimination d'un gros 
sequestre maxillaire — Rev. de 
stomatol., Paris, 1905, 198. 

Rodier. H. — Chancre syphilitique 
nevrogene de la levre superieure 
avec elimination d'un gros se- 
questre maxillaire — J. d. mal. 
cutan. et Syph., Paris, 1905, 
xvii, 401. 

Rodiet. A. — Les troubles oculaires 
dans des encephalopathies dif- 
fusees ou circonscrites de la 
syphilis — Bull, et mem. Soc. de 
med. de Vauclause Avignon, 
1906, ii, 445-448. 

Rolleston, J. D. — Hereditary syph- 
ilis and enteric fever, a case 
with commentary — Brit. M. J., 
Lond., 3 906, i, 312. 

Rolleston, J. D. — A case of intra- 
nasal chancre simulating nasal 
diphtheria — Lancet, Lond., 

1906, i, 1682. 

Rolleston, J. D. — Two cases of syph- 
ilis simulating typhoid fever — 
Med. Press and Circ, Lond., 

1907, ns, lxxxiii, 307. 

Rollet — Gomme de l'iris syphilides 
papulo-squameuses general- 
isees chez une flllette syphilis 
hereditaire tardive ou syphilis 
acquise? — Lyon med., 1906, cvi, 
987-989. 

Rollet — Formes cliniques de la syph- 
ilis gommeuse de l'iris — Bull, 
et mem. soc. franc, d'opht., 
Paris, xxv, 261-270. 

Roily, F. — Die Wassermannsche 
seroreaktion bei lues und an- 
deren infektionskrankheiten — 
Miinchen med. Woch., 1909, lvi, 
62. 

Rolshoven, F. — Ueber das vorkommen 
der spirochete pallide im blute 
—Med. klin., Berl., 1907, iii, 
989. 

Romero, J. F. — Un obscuro caso de 
sifilis papulosa tornado como 
lepra tuberosa — Cron. med. 
mexicana, Mexico, 1906, ix, 281- 



Recent Bibliography. 



383 



Eona, S. u. Preis, K. — A spirochteta 
pallidaro] — Budapest k. orvo- 
segy, evko. yve., 1905, 113-117. 

Rona, S. u. Preis, K. — Ueber die 
spirochseta pallida — ■ Ungar. 
med. Prease, Budapest, 1905, x, 
562. 

Rona, S. u. Preis, K. — A spirochseta 
pallidarol — Orvosi hetil., Buda- 
pest, 1905, xlix, 792. 

Rona, S. — Ueber die spiroehseten im 
allgemeinen • — Pest, med-chir. 
Presse, Budapest, 1906, xlii, 
457. 

Rona, S. — A spirochaetakrol — Or- 
vosi hetil, Bud., 1906, 1, 65-70. 

Rona, S. — Experimented superin- 
fektion im latenzstadium der 
syphilis — Ungar. med. Presse, 
Budapest, 1907, xii, No. 16-6. 

Rona, S. — Experimental superinfec- 
tion in two cases of syphilis 
latent — Orvosi hetil, Budapest, 
1907, li, 95. 

Rona, S. — My experiences on the 
practical value of the Schaud- 
inn spirochseta — Orvosi hetil, 
Budapest, 1907, li, 161. 

Rona, S. — Experimentelle superin- 
fektion im zweiten latenz-sta- 
dium der syphilis — Pest med- 
chir. Presse, Budapest, 1907, 
xliii, 218. 

Ronchi, G. — Oontributo alio studio 
del sifiloderma pigmentario 
primitivo — Riforma med., Pal- 
ermo-Napoli, 1906, xxii, 734- 
739. 

Rondoni, P. — Beitrage zur theorie 
und praxis der Wassermann'- 
schen syphilisreaktion 1 mitteil- 
ung; ueber den einfluss der ex- 
traktivverdiinnung auf die re- 
aktion— Berl. klin. Woch., 1908, 
xlv, 1968-1971. 

Roque, G. et Ja.mbon, A. — Un cas 
de syphilis tertiaire maligne a 
determinations gommeuses mul- 
tiples — Bull. Soc. med. d. hop. 
de Lyon, 1907, vi, 94. 

Roque, G. et Jambon, A. — Syphilis 
maligne a determinations gom- 
meuses multiples — Prov. med., 
Paris, 1907, xx, 247-250. 

Roque, G. et Jambon, A. — Un cas 
de syphilis tertiaire maligne a 
determinations gommeuses mul- 
tiples — Lyon med., 1907, cviii, 
739. 



La Rosa, G. — La questione sifilide 
a matrimonio considerata dal 
punto di vista dei suoi rapporti 
con le recenti esperienze della 
sifilide sperimentale — Pratica d. 
med., Napoli, 1906-7, vii 260. 

Roscher — Fall von lues maligna — 
Berl. klin. Woch., 1906, xliii, 
403. 

Roscher — Untersuchungen ueber das 
vorkommen von spirochsete pal- 
lida bei syphilis — Berl. klin. 
Woch., 1905, xlii, 1382, 1418, 
1447. 

Roscher — Spirochsete pallida und 
syphilis — Med. Klin., Berl., 
1906, ii, 62-64. 

Roscher — Fall von lues maligna — 
Dermat. Ztschr., Berl., 1906, 
xiii, 667. 

Rosenbach, O. — Geniigt die moderne 
diagnose syphilitischer erkriink- 
ung wissenschaftlichen forder- 
ungen? — Berl. klin. Woch., 
1906, xliii, 1157. 

Rosenberger, R. C. — The spirochete 
found in syphilis — Proc. Path. 
Soc, Phila.* 1906, ns. ix, 49-62. 

Rosenberger, R. C. — The spiroehfetse 
found in syphilis; a report of 
thirtv-four cases — Am. J. M. 
Sc, Phila. and N. Y., 1906, ns. 
cxxxi, 143-153. 

Rosenberger, R. C. — Present status 
of the etiology of syphilis; the 
spirocheta pallida, its biology 
and etiological relation to the 
disease — Proc. Path. Soc, 
Phila., 1908, ns. xi, 68-92. 

Rosenberger, R. C. — The present 
status of the aetiology of syph- 
ilis; the spirochseta pallida, its 
biology and aetiological rela- 
tion to the disease — N York M. 
J., 1908, lxxxvii, 391-400. 

Rosenthal, O. — Pflegeheime fur kin- 
der mit ererbter syphilis — Med. 
Reform., Berl., 1909, xvii, 349. 

Rosmarin, H. — Hereditary immu- 
nity to syphilis and the so-called 
law of Profeta — Lwow. tygodn 
lek., 1906, i, 331. 

Rosmarin, H. — Endemic of syphilis 
in the vilayet of Kossowo — 
Lwow. tygodn. lek., 1908, iii, 
245-262. ' 

Ross, F. W. — some of the inconsis- 
tencies of the behavior of syph- 
ilitic cases — Am. J. Dermat. 
and Genito-Urin. Dis., St. 
Louis, 1907, xi, 88. 



384 



Recent Bibliography. 



Rossi, 0. — Dati statistici e consid- 
erazioni critiche sulla prova di 
Wassermann nella diagnosi 
della siftlide della tabe e della 
paralisi progressiva — Riv. di 
patol. nerv., Firenze, 1909, xiv, 
22-41. 

Rost — Ueber syphilis maligna — 
Dermat. Ztschr., Berl., 1908, xv, 
271, 353. 

Rostaine, P. — Les heredo-sivphilit- 
iques prennent-ils la syphilis? 
— Ann. d. mal. ven., Paris. 1907. 
ii. 17-33. 

Roteh, T. M. — Gonorrhoea and syph- 
ilid m infancy and sari* child- 
hood — Internal. Clin., Phila., 
1907, 17, s. ii, 212-224, 2 pi. 

Roth, A. — Ueber die Porgesche 
syphilisreaction — Pest med. 
chir. Presse. Budapest, 1908, 
xliv. 1205-1209. 

De Rothschild. H.— Syphilis ter- 
tiaire de la face, dorsale de la 
main — Bull. Roc. franc, de der- 
mat. et syph.. Paris, 1905. xvi, 
59. 

Rothschuh, E. — Syphilitisehe famil- 
iengeschichten aus Central 
America — Berl. klin. Wclinschr.. 
1907, xliv, 958. 

Rothschuh, E. — Die syphilis in Zen- 
tralamerika — Arch. f. Schiffs-u. 
Tropenhvg., Leipz., 1908. \ii. 
109-133." 

Rotsam. E. A. — Non-sexual chancre 
upon the penis — Russk. j. 
kozhn. i. ven. boliezn, Kharkov. 

1905, x. 34. 

Roussel— La syphilis experimentale 
de l'oeil du lapin — Progres 
med.. 1908. 3s. xxiv. 376. 

Rowell, E. E. — Spirochaete pallida 
in syphilis — N. Am. J. Home- 
op.. N. Y.. 1900, liv, 358-362. 

Roy. P. — La preoeupation hypo- 
chondriaqne de la paralysie 
generate chez les syphilitiques 
— J. de psycho), norm, et path.. 
Paris, 1905. ii. 229-238. 

Rover — Deux eas de phagedenisme 
tertiaire observes et gueri* :1 
Challes — J. de med. de Paris. 

1906. 2 s. xviii. 204. 

Rucker. 51. P. — Congenital syphilis 
— Old Dominion J. M. and S., 
Richmond, 1907-8. vi. 476-482. 

Rudnitski, N. M. — Perigenital chan- 
cre — Russk. j. kozhn. i. ven. 
bokiezn, Kharkov, 1905, ix, 285. 



Ruprecht, M. — Beitrag zu den ter- 
tiaren erscheinungen der syph- 
ilis am gaumen — Monatschr. f. 
Ohrenh., Berl., 1907, xli, 635- 
640. 

Russell, F. F. — Spirochseta pallida 
in the lesions of syphilis — J. 
Am. M. Ass., Chicago, 1905, 
xlv, 1182. 

Russell, F. F. — The comparative 
morphology of the spirochetes of 
syphilis and yaws ( f ramboesia 
tropica) — Arch. Int. Med., Chi- 
cago, 1908, ii, 74-76, 1 pi. 

Ryersi hi, (',. S. — Some syphilitic af- 
fections of the eye and ear — 
Am. .T. Dermat. and Crenito- 
Urin. Dis., St. Louis, 1906, x, 
168. 

Ryerson, (J. S. — Some syphilitic af- 
fections of the eye and ear — 
Canada Lancet, Toronto. 1907- 
s. xli, 522-524. 



S 



Sabrazes, J. et Duperie, R. — Spiro- 
chetes et lesions syphilitiques 
d'un foetus chetes et lesions de 
six miiis iridocyclite specifique 
— Compt. rend. Soc. de bio)., 
Paris, 1908, lxv, 452. 

Sabrazo-. .1. et Duperie. R. — Thio- 
nine picriquee impregnation ar- 
gentique des spirochetes — Oaz. 
hebd. (1. sc. med. de Bordeaux, 
1909. xxx, 207. 

Sabrazes. .1. et Duperie. R. — Passage 
du spirochete de Schaudinn 
dans le cytoplasme des fibres 
musculaires lisses chez un her- 
edo-syphilitique sa nonpenetra- 
tion dans les cellules nerveuses 
— Compt. rend. soc. de biol., 
Paris. 1909, lxvi. 1101. 

Sabunavrff M — Priman yfhilicin 
subjects who have already bad 
the disease — Sibirsk. Vrach 
Viedom, Kransovarsk. 1906, iv, 
94-96. 

Sachs, H. u. Altmann. K. — Ueber 
die Wassermannsche serodiag- 
nostik der syphilis — Deutsche 
med. Wocli.. Leipz. u. Berl., 
1908, xxxix, 529. 

Le Sage, J. A. — L'avariose peril so- 
cial — Union med. du Canada, 
Montreal, 1905, xxiv, 255-269. 



Recent Bibliography. 



385 



Sagher, P. — Le diagnostic elinique 
precoce de l'heredo-syphilis- — 
Scalpel, Liege, 1908-9, lxi, 501- 
504. 

Saito — Two cases of diseased pe- 
trous bone in patients suffering 
from obstinate syphilis — Tokyo 
Iji-Shinshi, 1906', 2429-2456. 

Sakurane, K. — Histologische unter- 
suchungen ueber das vorkommen 
der spirochete pallida im ge- 
weben — Arch. f. dermat u. 
syph., Wien u. Leipz., 1906, 
Ixxxii, 227-239, 1 pi. 

Sakurane, K. — Histological re- 
searches on the appearance of 
spirochete pallida in the tis- 
sues — Hifukwakiu Hiniokikwa 
Zasshi, Tokyo, 1907, vii, 1-17. 

Sakurane, K. — Ueber die histolog- 
ische untersuchung der spiro- 
chete pallida — Hifukwakiu 
Hiniokikwa Zasshi, Tokyo, 
1907, vii, 414-421. 

Salager, E. — Syphilis et confusio 
mentale — ■ Eneephale, Paris, 
1907, ii, 103-106. 

Saling, T. — Die sogenannte luesspi- 
rochete; eine erwiderung (an 
Levaditi ) — Wien klin. Rund- 
schau, 1906, xx, 849, 866. 

Saling, T. — Zur kritik der spiro- 
cheta pallida Schaudinn— Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena, 1906, xli, 737. 

Saling, T. — Kritische betraehtungen 
ueber die sogenannte syphilis- 
spirochete — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1906-7, 
xliii, Orig. 70. 

Saling, T. — Kritische betraehtungen 
ueber die sogenannte syphilis- 
spirochete in die silverspiro- 
chate — Centralbl. f. Bakteriol., 
1 Abt., Jena, 1906-7, xliii, Orig. 
162. 

Saling, T. — Erwiderung auf den 
vorstehenden artikel des Herrn 
Wolff beitreffend die spirocha- 
ten-frage — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1906-7, 
xliii, 229. 

Saling, T. u. Hoffmann, E.— Die 
aetiologie der syphilis in krit- 
iseher beleuchtung — Wien klin. 
Rundschau, 1907, xxi, 133, 150. 

Salisbury, J. H. — The influence of 
syphilis upon health and lon- 
gevity — Med. Exam, and Pract., 
N. Y., 1907, 123. 



Salisbury, J. H. — The influence of 
syphilis upon health and lon- 
gevity — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1906, x, 247-254. 

Salmon, P. — Contribution du labo- 
ratoire au diagnostic elinique 
du chancre syphilitique — Arch, 
gen. de med., Paris, 1905, ii, 
2646-2653. 

Salmon, P. — Debuts de syphilome 
initial — Compt. rend. Soc. de 
biol., Paris, 1905, lix, 9. 

Salmon, P. — Presence du spirochete 
pallida chez un enfant syphilit- 
ique hereditaire — Compt. rend. 
Soc. de biol., Paris, 1905, Iviii, 
883. 

Salmon, P. — La spirille de la syph- 
ilis — Medecin. prat., Paris, 
1906, 147. 

Salmon, P. — Sur 1'immunite des 
syphilitiques tertiaires — Compt. 
rend. Soc. de biol., Paris, 1907, 
lxii, 254. 

Salomone, G. — Sulle atropatie sifi- 
litische — Ann. di med. nav., 
Roma, 1908, xiv, 378-387. 

Salomensen, L. W. — De l'influence de 
la syphilis sur la duree de la 
vie humaine — Bull, de 1'Ass. 
internat. d. med-exp. de comp. 
d'assur, Brux., 1906, v, 154. 

Salomonsen, L. W. — Der einfluss der 
syphilis auf die lebensdauer — 
Ber. u. Verhandl. d. internat. 
Kong. f. Versicher — Med., Berl., 
1906, 193. 

Salvini, E. — Sopra un caso di ter- 
ziarismo precoce con gomme 
dei corpi cillari — Riforma med., 
Palermo-Napoli, 1907, xxiii, 
1094-1098. 

Sanchez, Hernandez, A. — Un asten- 
ico simple, con sifilis — Siglo 
med., Madrid, 1905, lii, 802. 

De Sanctis, S. and Lucongeli, G. L. 
■ — Heredo-syphilis ; form of in- 
fantile multiple sclerosis (fam- 
ilia sclerotiform heredo-syph- 
ilis)— J. Ment. Path., N. Y., 
1905-6, vii, 1-20. 

De Santos, Saxe, G. A. — The serum 
diagnosis of syphilis; a syn- 
thetic review of the progress 
gained in this field during the 
year 1908— Am. J. Urol., N. Y, 
1908-9, v, 54-105. 



386 



Recent Bibliography. 



Sanz, Bombin — Enferemedades par- 
asifiliticas; diagnostico retro- 
spective) de la sifilis — Rev. es- 
pan. de dermat. v sif., Madrid, 

1905, vii, 193-206. 

Saraceni. C. — La endoarterite oblit- 
erante e la infiltrazione pericap- 
illare come causa di porpora e 
di emorragie nei sifilitici — Gior. 
ital. d. mal. ven., Milano, 1905, 
xl, 518-530. 

Saraceni, F. — Febbre-frattura spon- 
tanea e piginentazione sifilitica 
— Gazz. med. di Roma, 1909, 
xxxv, 421-433. 

Sargnon — Papilloma de la luette 
glycosurie passagere expectora- 
tion purulent* et haleine fetide 
syphilis ancienne; signes fone- 
tionnels d'aortisme gomme tho- 
racique superieure gauche prob- 
ablement ganglionnaire ouverte 
dans la trachee — Lvon med., 

1906, cvii, 282-286. 

Sana, G. — Una prova con deduzioni 
statistiche che la sifilide nella 
maggioranza dei casi si esaur- 
isee in periodo secondario — 
Gazz. intcrnaz. di med., Napoli. 

1907, x. 301-303. 

Sattler, M. — The discovery of spiro- 
chete in syphilis — Lijec vijest- 
nik u. Zagrebu. I!i00, xxviii. 
169-175. 

Saunders. A. — A case of syphilitic 
osteitis present'ng resem- 
blances to osteitis deformans— 
— West Lond. M. J., Lond., 
1906, xi, 193. 

Saunders, A. — Notes on case of late 
hereditary syphilis — West 
Lond. M.'.L, 1909, xiv, 198-200. 

Sauvage et Levaditi, C. — Sur un 
cas de syphilis hereditaire — 
Compt. rend. Soc. d'obst. de 
gynec. et de pediat. de Paris, 
1906. viii. 15-22. 

Sauvan, A. — Des perforations du 
voile du palais en dehors de la 
syphilis — Marseille med., 1909, 
x'lvi, 513, 562, 590, 624, 654. 

Sauvineau — Chancre syphilitique de 
la conjonetive bulbaire — Ann. 
d'ocul., Paris, 1906, exxxv. 390- 
395. 

Savin, F. A. — Syphilis of the male 
population of Astrakhan, 1898- 
1902 — Med. Obnzr.. Mosk.. 
1905, lxiii, 115. 



Saxe, G. de S. — The diagnosis of 
late hereditary syphilis in the 
school child — Arch. Pediat., N. 
Y., 1906, xxiii, 914-924. 

Sberna, S. — Un altro micro-organ- 
ismo della sifilide sara; il suo 
agento patogeno ? — Clin, med., 
Firenze, 1905, xi, 382. 

Scalinci, N. — Iridite gommoso mil- 
iare de eredo-sifilide — Rif. ital. 
di ottal., Roma, 1909, iv, 238- 
246. 

Schalek — Generalized tubercular 
gummata — ,7. Cutan. Dis. incl. 
Sypb., N. Y., 1905, xxiii, 184. 

Schalek, A. — Serum diagnosis of 
syphilis — West. M. Rev., Oma- 
ha. 1908, xiii, 616-619. 

Schalek, A. — Practical value of 
modern conceptions of syphilis 
— J. Am. Ass'n., Chicago', 1908, 
1. 1409-1411. 

Schalek. A. — Prophylaxis of syph- 
ilis — Illinois M. J., Springfield, 
1905, ns. viii, 21. 

Schamberg — A case of chancre of 
the anus — J. Cutan. Dis. incl. 
Syph.. N. Y., 1908, xxvi, 478. 

Scharb, G. — Syphilis varioliforme 
myelocytose et eosinophilic — 
Bull. med. de 1'Algerie, Alger, 
1908, xix. 620-624. 

Scharpff, A. — Zur frage der aorten- 
veriinderungen bei kongenitaler 
syphilis — Frankf. Ztschr. f. 
Path.. Wiesb., 1908, ii, 287- 
294. 

SchatilorT. P. u. Isabolisnky, M. — 
Untersuchungen ueber die Was- 
sermann-Neisser-Brucksche re- 
aktion bei syphilis — Ztschr. f. 
Imnmnitatsforsch u. exper. 
therap., Jena, 1908-9, i, 316- 
340. 

Schaudinn, F. u. Hoffmann, E. — 
Ueber spirochstenbefunde im 
lymphdrusenhaft syphilitischer 
— Deutsche med. Woch., Lcipz. 
u. Berl., 1905, xxxi, 711. 

Schaudinn, F. — Zur kenntnis der 
spirochaete pallida — Deutsche 
med. Woch., Leipz. u. Berl., 
1905, xxxi. 1665. 

Schaudinn, F. u. Hoffmann, E. — 
Ueber spirocha?tae pallida bei 
syphilis und die unterscheide 
dieser form gegeniiber anderen 
arten dieser gattung — Berl. 
klin. Woch., 1905, xlii, 673. 



Recent Bibliography. 



387 



Schaudinn, F. u. Hoffmann, E. — 
Ueber spirochete pallida bei 
syphilis und die unterseheide 
dieser form gegeniiber anderen 
arten dieser gattung — Berl. 
klin. Woeh., 1B05, xlii, 673- 
675; Discussion 731-734. 

Sclierb et Sicard — Anthropathies 
tertiaires — Bull. med. de l'Al- 
gerie, Alger, 1905, xvi, 41. 

Scherb — Trismus syphilitique ter- 
tiarisme angulomaxillaire et 
du masseter — Bull. med. de 
l'Algerie, Alger, 1905, xvi, 109. 

Sclierb — Famille syphilisee par con- 
tage buccal — Bull. med. de l'Al- 
gerie, Alger, 1907, xviii, 514. 

Scherber, G. — Beitrage zur klinik 
und histologie der nodosen 
svphilide — Arch. f. Dermat. u. 
Svph., Wien u. Leipz., 1906, 
lxxix, 163-186. 

Schereschewski, J. — Das verhalten 
der spirochete pallida ( Schaud- 
inn) bei der Giemsa farbung — 
Centralbl. f. Bakteriol.. 1 Abt., 
Jena, 1907, xlv, Orig. 91-94. 

Schereschewski, J. — Zum nachweis 
der spirochete pallida in Aus- 
trichen — Deutsche med. Woch., 
Leipz. u. Berl., 1907, xxxiii, 
462. 

Schereschewski, J. — Experimen- 
telle beitrage zum studium der 
syphilis — 'Centralbl. f. Bakter- 
iol.. 1 Abt., Jena, 1908, xlvii, 
41-56. 

Schereschewski, J. — Ziichtung der 
spirochete pallida ( Schaudinn ) 
— Deutsche med. Woch., Leipz. 
u. Berl., 1909. xxxv, 835. 

Schereschewski, J. ■ — Bisherige er- 
fahrungen mit der gezuchteten 
spirochete pallida — Deutsche 
med. Woch., Leipz. u. Berl., 
1909, xxxv, 1652-1654. 

Scheidenmantel — Ueber die Wasser- 
mann'sche serodiagnostik der 
lues — Munchen med. Woch., 
1908, lv. 2017. 

Scheidenmantel, E. — Ueber das we- 
sen die technik und klinische 
bedeutung der serodiagnostik 
der lues — Wurzb. abhandl. a. d. 
geb. d. prakt. med., 1909, xl, 
hit. 1-25. 

Scherber, G. — Die extragenital 
syphilis — Ztschr. f. Bekampf. d. 
Geschlechtskrankh., Leipz, 
1908, viii, 159-179. 



Scheuer, O. — Was leistet zur zeit 
die Wassermannsche serodiag- 
nostik der syphilis fiir die 
praxis? — Wien klin. Rund- 
schau, 1909, xxiii, 353-355. 

Scheuer, O. — Frilhdiagnose der 
syphilis mittels nachweisses der 
spirochete pallida im dunkel- 
feldapparate — Wien med. 
Woch., 1909, lix, 1947-1950. 

Schick, B. — Periostitis ossificans 
luetica in einem kinde — Mitt, 
d. Gesellsch. f. inn. Med. u. 
Kinderh. in Wien, 1907, vi, 3. 

Schiller, L. — Syphilis in the light 
of modern research — Wiscon- 
sin M. J., Milwaukee, 1908-9, 
vii, 188-196. 

Schinkel, R. — La presence du spi- 
rocheta pallida dans un con- 
dvlome svphilitique — Bull. Soc. 
de med., 1905, 229. 

Schlasberg, H. J. — Studien ueber 
syphilis bei kontrollmadchen 
speziell in bezug auf den ter- 
tiarismus — Ztschr. f. Bekampf. 
d. Geschlestskrankh.. Leipz., 

1908, viii, 195-231-271. 
Schlasberg, H. I. — Studies of syph- 
ilis in prostitutes under con- 
trol, especially in regard to ter- 
tiary forms — Hygeia, Stock- 
holm, 1908, 2 F. viii, 401-452. 

Schleisinger, F. S. — Periostitis gom- 
osa de la hendidura esfenoidal 
— Arch, de oftal. hispano-am., 
Bareel., 1908, viii, 64-68. 

Schlesinger, H.— Multiple fieberhaft 
verlaufende luetische gelenks- 
schwellung und osteoperiostitis 
luetica — Mitt. d. Gesellsch. f. 
inn. med. u. kinderh. in Wien, 

1909, viii, 177. 

Schlimpert, H. — Spirochatenbefunde 
in den organen kongenital 
syphilitischer neugeborener — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 1037. 

Schlimpert, H. — Pathologisch-anat- 
omische befunde an den augen 
bei zwei fallen von lues congen- 
ita — Deutsche med. Woch., 
Leipz. u. Berl., 1906, xxxii, 
1942. 

Schlimpert, H. — Beobachtung bei 
der Wassermannsehen reaktion 
— Deutsche med. Woch., Leipz. 
u. Berl., 1909, xxxv, 1386-1389. 



388 



Recent Bibliography. 



Schlossmann, A. — Sind besondere 
heinie fiir syphilitische kinder 
notwendig oder wunschenswert ? 
— Med. reform., Berk, 1908, xvi, 
133-135. 

Schmidt, H. E. — Zur bedeutung der 
blutuntersuchung bei latenter 
syphilis — Berl. klin. Wchnschr., 
1908, xlv. 2089. 

Schmidt, L. E. — Case of syphilitic 
imtial lesion followed by 
epithelioma — J. Cutan. Dis. 
inel. Svpli., X. Y., 1907, xxv, 
275. 

Schmidt. M. B. — Ueber syphilitische 
osteochondritis — Verhandl. d. 
deutseh. path. Gesellsch., 190, 
Jena. 1906, 233-239, 1 pi. 

Schmoll — A propos d'un nouveau 
jugement sur un fait de con- 
tamination syphilitique — Soc. 
franc, de prophyl. san et mor. 
Bull.. Paris, 1907, yii, 279-307. 

Schmorl, G. — Die farbung der spiro- 
chete pallida im schnittprii- 
parat nach Giemsa — Deutsche 
med. Woch., Leipz. u. Berl., 
1907, xxxiii, 876. 

Schmorl. G. — Mitteilung zur spiro- 
chatenfrage — Miinchen med. 
Worn.. 1007, liv. 1SS. 

Schneider — Ueber spirochaeten gewe- 
beschnitten — Miinchen med. 
Woch., 1906, liii, 1279. 

Schneider — Ueber spirochete pallida 
im gewebe — Deutsche med. 
Woch., Leipz. u. Berl., 1906, 
xxxii, 1360. 

Schoenfeld. H. — Chancre indure de 
la paroi posterieure du vagin 
diagnostique par la methode 
bacterioloeique — Bull. Soc. 
beige, de gvnec. et d'obst., 
Brux.. 1905-6'. xvi, 67. 

Schoenfeld. H. — Sur la recherche 
du spirochseta pallida de 
Schaudinn dans les cas douteux 
de syphilis: un cas de chancre 
yaginal — Bull. Soc. de med. de 
Cand.. 1905. lxxi. 216-220. 

Schoonfield. P. H. — Het tegenwoor- 
dig standpunt der experimen- 
teele syphilis en der syphilis- 
aetiologie algemeen oyerzicht 
der nieuwe gezichtspunten — 
Med. Weekbl., Amst., 1907-8, 
xiy, 41-69. 

Schoonheid. P. H. — De serodiagnos- 
tik der syphilis en hare yaarde 
yoor de praktijk — Med. Weekbl., 
Amst,, 1908-9, xv, 97-108. 



Schoonheid, P. H. — Opmerkingen 
naar aanleiding van het artikel 
"herpes bij syphilitischen" — 
Med. Weekbl., Amst., 1908, xlv, 
629. 

Schourp — Ein fall von schwarzer 
haarzunge bei syphilis — Mon- 
atschr. f. Harnkr. u. sex. Hyg., 
Leipz., 1906, iii, 58-60. 

Schridde, H. — Ueber extravaskulare 
blutbildung bei angeborener 
lymphocythamie und kongenit- 
aler syphilis - — Verhandl. d. 
deutseh. path. Gessellsch., 
1905, Jena, 1906. 220-224, 1 pi. 

Schridde, H. — Spiroehsetenbefunde 
in organen und ihre verwertung 
fiir die diagnose und den infek- 
tionsmodus der syphilis — 
Miinchen med. Woch., 1906, 
liii, 1892. 

Schubert — Demonstration von 2 fal- 
len von viszeraler lues — 
Miinchen med. Woch.. Leipz. u. 
Berl., 1906, liii, 1276. 

Schucht, A. — Zur experimentellen 
uebertragung der syphilis auf 
kaninchenaugen — Miinchen 
mod. Woch.. 1907. liv, 110. 

Schueller, M. — Protozoic parasites 
of syphilis — Am. J. Dermat and 
Genito-Urin. Dis., St. Louis, 
1907, xi, 209. 

Schuffner, W. — Die spirochseta per- 
tenuis und das klinische bild der 
framboesia tropica — Miinchen 
med. Wchnschr., 1907, liv, 
1364-1368, 1 pi. 

Schuktz. O. T. — The distribution of 
treponema pallidum Schaudinn 
(spirochaeta pallida) in the tis- 
sues in congenital syphilis — J. 
Med. Research. Bost.', 1906, xv, 
363-381, 1 pi. 

Schulin, C. — The pathology of syph- 
ilis — Am. J. Dermat. and Gen- 
ito-Urin. Dis., St. Louis, 1907, 
xi, 220. 

Schull, E. — De l'insomnie syphilit- 
ique — Gaz. med. de Paris, 1908, 
No. 26. 5. 

Schuller, M. — Ueber hereditar syph- 
ilitische herderkrankungen bei 
kindern und die verbreitung der 
protozoischen parasiten in den- 
selben — Dermatol. Ztschr., 
Berl., 1905. xii, 1-24. 

Schuller, M. — Ueber die protozoi- 
schen erreger der syphilis — 
Deutsche Aerzte-Zte., Berl, 
1905. 265. 



Recent Bibliography. 



389 



Schuller, M. — Ueber die protozoi- 
schen parasiten bei syphilis — 
Gentralbl. f. Bakteriol., 1 Abt., 
Jena, 1907, xliii, Orig. 704-803. 

Schultz, 0. T. — A preliminary re- 
port of the staining of spiro- 
ch*ta pallida (treponema pal- 
lidum) in the tissues of a case 
of congenital syphilis — Am. 
Med., Phila., 1906, ns. i, 30. 

Schultz, 0. T. — The present status 
of our knowledge of the para- 
sitology of syphilis — J. Cutan. 
Dis. incl. Syph., N. Y., 1907, 
xxv, 429-441. 

Schultz, 0. T. — The numerical rela- 
tionship of treponema pallidum 
to certain pathological types of 
congenital syphilis — J. Infect. 
Dis., Chicago, 1909, vi, 17-37. 

Schultz, 0. — The present status of 
our knowledge of the parasit- 
ology of syphilis — Internat. 
Dermat. Cong. Tr., N. Y., 1908, 
ii, 708-728. 

Schulze, W. — Ueber den spirochaten- 
nachweis bei syphilis — Deutsche 
med. Woch., Leipz. u. Berl., 

1905, xxxi, 1467. 

Schulze, W. — Impfungen mit lues- 
material an kaninchenaugen — 
Klin. Monatsbl. f. Augenh., 
Stuttg., 1905, ii, 253-266. 

Schulze, W. — Der cytorrhyctes luis 
in der mit syphilis geimpften 
kaninchen-iris — Verhandl. d. 
Berl. ophth. Gesselsch, 1905, 
Leipz., 1906, 14. 

Schulze, W. — Das verhalten des 
cytorrhycytes luis (Siegel) in 
der mit syphilis geimpften kan- 
inchen-iris — Beitz. z. path, 
anat. u. allg. path., Jena, 1906, 
xxxix, 180. 

Schulze, W.— Der cytorrhyctes luis 
siegel in der mit syphilis 
geimpften kanancheniris — Berl. 
klin. Wochnschr., 1906, xliii, 
370. 

Schulze, W. — Dis siberspirochste — 
Berl. klin. Woch., 1906, xliii, 
1213-1216. 

Schulze, W— Zur frage der silber- 
spirochate — Berl. klin. Woch., 

1906, xliii, 1654. 

Schulze, W. — Bemerkungen zu den 
kaninchenaugenimpfungen — 
Med. Klin., Berl., 1907, iii, 552. 



Schulze, W. — Die silberspirochaten 
in der kornea — Klin. Monatsbl. 
f. Augenh., Stuttg., 1907, xlv, 
466-475, 1 pi. 

Schumacher, G. — Die serodiagnose 
der syphilis in der augenheil- 
kunde nebst bemerkungen ueber 
die beziehungen der tuberkulose 
zur syphilis bei augen leiden — 
Deutsche med. Woch., Leipz. u. 
Berl., 1909, xxxv, 1914-1919. 

Schurmann, W. — Luesnachweis 
durch farbenreaktion — Deutsche 
med. Woch., Leipz. u. Berl., 
1909, xxxv, 616. 

Schurmann, W — Ein kunstliches 
extrakt zur anstellung der lues- 
reaktion — Med. Klin., Berl., 
1909, v, 627. 

Schuster, E. — Der nachweis der spi- 
rochete pallida, seine bedeutung 
und praktische verwertbarkeit 
fur die diagnose der syphilis — 
Berl. klin. Woch., 1907, xliv, 
549. 

Schutze, A. — Experimenteller bei- 
trag zur Wassermann'schen 
serodiagnostik bei lues — Berl. 
klin. Woch., 1907, xliv, 126. 

Schutz, J. — Mitteilungen ueber spi- 
rochaeta pallida (Schaudinn) 
und cytorrhyctes ( Siegel ) — 
Milnchen. med. Wchnschr., 1906, 
liii, 543. 

Schwetz, J. — Un cas de syphilis 
maligne galopante compliquee 
d'alcoholisme — Rev. med. de la 
Suisse Bom., Geneve, 1908, 
xxvi, 85-89. 

Scott, C. D. — The manifestations of 
secondary syphilis — St. Louis 
M. Rev., 1907, lv, 350. 

Secchi. T. — Contributo alio studio 
della sifilide secondaria del 
fegato sifilide e malaria — Ri- 
forma med., Napoli, 1908, xxvi, 
89-99. 

Secchi, T.— Contribution a l'etude 
de la syphilis musculaire tar- 
dive — Ann. d. mal. ven., Paris, 
1908, iii, 481-512. 

Segard, M. — Osteite heredo-syphilit- 
ique — Clinique, Paris., 1909, iv, 
616. 

Segovia y Arquellada — Contagio en 
la alimentacion de los ninos 
sifiliticos — An. de la acad. de 
obst., 1909, ii, 52-57. 



390 



Recent Bibliography. 



Segovia y Arqueallada — Contagio en 
la ailmentacion de los ninos 
sifiliticos — Siglo med., Madrid, 
1909, lvi, 338-341. 

Seifert — Ein ungewohnliche art 
syphilitischer infektion — Mon- 
atsh f. prakt. dermat., Hamb.. 
1908. xlvii. 61. 

Seifert — Ueber tropensyphilis — 
Miinchen med. Woch., 1909, lvi, 
2318. 

Seleneff, J. Th. — Le chancre syph- 
ilitique noir — Ann. de mal. ven., 
Paris. 1908, iii, 161-168, 2 pi. 

Selenew, J. P. — Extragenital pri- 
maraffekte — M o n a t s e h. f. 
Harnkr. u. Sex. Hgv., Leipz., 
1906. iii, 249-256. 

Selenew, J. Th. — Tnfusoires dues ul- 
cere* Byphilitiques — Ann. d. 
mal. von.. Paris.. 1906, iii, 891- 
897, 1 fold. pi. 

Seligmann, E. — Zur kenntnis der 
Wassermannschen reaktion — 
Ztschr. f. ImnmnitStsforsch. u. 
exper. therap., Jena, 1908-9. i. 
340-351. 

Seligmann. E. u. Blume, G. — Die 
luesreaktion an der leiche — 
Perl klin. Woch., 1909, xlvi, 
116-120. 

Seligsohn ■ — Demonstration eines 
falles von primar-affekt des 
augenlidcs — Verhandl. d. Berl. 
ophth. Gesellsch., 1905, Leipz., 
1906, 8. 

Sellei, J. — Malignant syphilis and 
the study of immunity — Gyogy- 
aszat. Budapest. 1907, xlvii. 
156. 

Sellei. J. — Syphilis sine exanthemata 
— Monatsh. f. prakt. dermat., 
Hamb., 1908. xlvii, 441-444. 

Sellei, J. — Syphilis sine exanthemate 
— Gvogaszat. Budapest. 1908, 
xlviii, 530. 

Semon. Sir F — Tertiare syphilis 
oder pneumokokkeninvasion des 
gaumens — Monatschr. f . 
Ohrenh., Berl., 1907, xli. SOS- 
SOS. 

Senac, Lagrange — Du rapport des 
maladies syphilitiques avec les 
maladies parasyphilitiques ou 
maladies d'espece — Ann. soc. 
d'hvdrol. med. de Paris, C-r.. 
1908-9, liv, 159-178. 

Sensini, P. — Contribuzione all'etio- 
logia del sifiloma endouretrale 
cinque ca9i clinici — Gior. ital. 



d. mal. ven., Milano, 1906, xli 

386-392. 
Sequeira — Tertiary syphilis and leu- 

codermia — Brit J. Dermat, 

Lond.. 1905. xvii, 19. 
Sequeira, J. A. — Extensive gumma- 
tous ulceration around the 

mouth — Proc. Rov. Soc. Med. 

Lond., 1907-8; i. Dermat. Sect 

185. 
Sergent. E. — Syphilis et tubereulose 

— Arch. gen. de med.. Paris, 

1905. ii, 2497-2508. 
Sergent, E. — Les formes scrofuloides 

de la syphilis — Rev. internal de 

med. et de chir., Paris, 1908, 

xix, 201-203. 
Sergent, E. — Formes scrofuloides de 

la syphilis — Bull, et mem. Soc. 

med'. d. hop de Paris, 1908, 3 s. 

xxv, 351-356. 
Sergent, E. — La leucoplasie bueco- 

linguale en meilecine genera le, 

sa valeur semeiologique dans la 

recherche da la syphilis — Rev. 

sen. de clin. et de therap., Paris. 

xxiii. 65-70. 
Sezary, A. — Le treponema pallidum 

de Schaudinn — Med. mod., 

Paris. 1906, xvii, 185-188. 
Sezary, A. — Les determinations vis- 

ceralea latentes de la syphilis 

secondaire — Gaz. de hop., Paris, 

1907, Ixxx, 123-130. 
Sezary, A. — Technique et valeur de 

l'examen microbiologique dans 

la svphilis — Presse med., Paris, 

1907, xv. 849. 

Sezafy, A. — Processus histologiques 
de la reaction meningee de la 
syphilis secondaire ■ — Compt. 
rend. soc. de biol., Paris, 1908, 
lxiv, 576-578. 

Sezary. A. — Lesions histologiques du 
foie dans la syphilis secondaire 
— Compt. rend Soc. de biol., 
Paris. 1908. lxiv, 678-680. 

Sezary. A. — Ictere grave syphilitique 
de la periode secondaire anat- 
omie pathologique et microbi- 
ologic — Presse med., Paris, 

1908. xvi. 618. 

Sezary, A. — Sur la pathogenie du 
tabes et des affections para- 
svphilitiques en general — Presse 
med., Paris, 1909, xvii, 779-781. 

Shennon, T. — Spirochoeta pallida in 
svphilis — Lancet. Lond., 1906, 
i.' 663-667. 



Recent Bibliography. 



391 



Sherman, T. — The relation of spiro- 
chseta (spironema) pallida to 
syphilis. (Abstr. ) — Med. Press 
and Circ, Lond., 1906, ns. 
lxxxi, 118. 

Shennen, T. — Spiroeheta pallida 
(spironema pallidum) in syph- 
ilis— Tr. Med-Chir. Soe., Edinb., 

1906, ns. xxv, 111-125, 3 pi. 
Shennan, T. — The localisation of 

spirochetes in the papules of 
yaws — J. Path, and Bacteriol., 
'Edinb. and Lond., 1908, xii, 
426-429. 

Shereshevski, Ya. G. — Experimental 
data in syphilis — Med. Obozr., 
Mosk., 1909, lxxii, 42-50. 

Shields, E. H. — Syphilis insontium 
Lancet-Clinic, Cincin., 1905, ns. 
lv, 666. 

Shields, E. H. — Syphilis hereditaria 
tarda — Lancet-Clinic, Cincin., 

1907, ns. Iviii, 357. 
Shillitoe, A. — Case of circinate ery- 
thematous syphilide — Proc. 
Roy. Soc. Med., Lond., 1907-8, 
i. Dermat. Sect. 21. 

Shiperskaya, Anna K. — Investiga- 
tion of the psychical condition 
of children with hereditary 
syphilis — Russk. j. kozhn. i. 
ven. boliezn, Kharkov, 1909, 
xvii, 128-199. 

Shiskina-Yavelin, Mme. P. N. — 
Serum diagnosis of syphilis — 
Russk. Vrach., S. Petersb., 

1908, vii, 641-645. 
Shoemaker, J. V. — Tertiary syphilis 

rupia — Med. Fortnightly, St. 
Louis, 1905, xxvii, 268. 
Shoemaker, J. V. — Secondary syph- 
ilis; small papular syphilide — 
Med. Fortnightly, St. Louis, 

1905, xxvii, 268." 
Shoemaker, J. V. — Tertiary syhpilis 

(a clinical lecture) — Am. J. 

Dermat. and Genito-Urin. Dis. 

St. Louis, 1907, xi, 83. 
Shoemaker, J. B. — Syphilis squam 

osa— Med. Era, St. Louis, 1909 

xviii, 9-11. 
Shoemaker, J. V. — Syphilis — Month 

Cycl. and M. Bull., Phila., 1909 

ii, 39-41. 
Shoets, Y. — Malignant rapid syph 

ilis — Vrach. Gaz., St. Petersb. 

1906, xiii, 175. 

Shor, G. V. — K voprosu o spirochete 
pallida — Russk. Vrach, S. 
Petersb., 1905, iv, 1123. 



Shtsherbakoff, A. S.— Syphilis and 
venereal diseases among the 
Kuban Cossacks, and their in- 
fluence upon hereditary — Russk. 
j. kozhn. i. ven, boliezn., Khar- 
kov, 1907, xiii, 230-232. 

Shuttleworth, G. E. — Inherited syph- 
ilis as a factor in the etiology 
of mental defect in children — 
Brit. J. Child. Dis., Lend., 1908, 
v, 141-144. 

Shuttleworth, G. E. — Inherited syph- 
ilis — Rep. Soc. Study Dia. 
Child., Lond., 1908, viii, 171- 
174. 

Shvets, Y. — The presence of spiro- 
chete pallida and the possibility 
of their recognition in syphilitic 
disease of the mouth — Vrach. 
Gaz., S. Petersb., 1906, xiii, 
489. 

Sicard and Seherb — Polyethalite in- 
fantile — Bull. med. de 1'Algerie, 
Alger, 1905, xvi, 367. 

Siebert, C. — Ueber die spirochete 
pallida — Deutsche med. Woch., 
Leipz. 1. Berl., 1905, xxxi, 1642. 

Siebert, W. — Fieber in spatstadium 
der syphilis — Beihefte z. Arch. 
f. Schiffs-u. Tropenhyg., Leipz., 
1907, Beihft. 4, 1-33, 1 diag. 

Siege! , J. — Neue untersuehungen 
ueber die aetiologie der syphilis 
morphologie der cytorrhyctis 
luis — Miinehen med. Woch., 
1905, lii, 1321. 

Siegel, J. — Die neuesten atiologi- 
schen syphilisforschungen ; 2 un- 
tersuehungen ueber die aetiolo- 
gie der syphilis — Halbmonat- 
schr. f. Haut-u Harnkr., Wien, 

1905, ii, 81. 

Siegel, J. — Weitere untersuehungen 
ueber die aetiologie der syphilis 
— Miinehen med. Wchnschr., 

1906, liii, 63-66, 1 pi. 

Siegel, J. — Der erreger der syphilis 
— Centralbl. f. Bakteri'ol., 1 
Abt., Jena, 1907, xlv, Orig. 218- 
230. 

Siegel, J. — Experimentelle studien 
ueber syphilis — Centralbl. f. 
Bakteriol., 1 Abt., Jena, 1907, 
xliii, Orig. 456-569, 1 pi. 

Siegel, J. — Einige erganzende bemer- 
kungen zu meinen aufsatz der 
syphiliserreger in Bd. xliv 
Ztschr. — Centralbl. f. Bakteriol., 
1 Abt., Jena, 1908, xlvi, Orig. 
315-318. 



392 



Recent Bibliography. 



Siegel. J. — Zur aetiologie der svph- 
ilis— Med. Klin., Berl., 1906, i. 
94. 

Siegel, J. — Experimentelle studien 
ueber syphilis 2. Der erreger 
der syphilis — Centralbl. f. Bak- 
teriol'., 1 Abt, Jena, 1907, xlv, 
Orig. 301, 401, 5 pi. 

Siegel, J. — Uebertragung der syph- 
ilis auf mause vorliiufige mit- 
teilung — Centralbl. f. Bakteriol., 
1 Abt., Jena, 1908-9, xlviii, 
Orig. 599. 

Siems, C. et Rajat, H. — Chancre 
syphilitique des fosses nasales — 
Bull. Soc. med. d. hop. de Lvon, 

1907, vi, 270. 

Siems. C. et Rajat, H. — Un cas de 
chancre syphilitique des fosses 
nasales — Bull, de laryngol, otol 
et rhinol., Paris, 190/, x, 277. 

Silvestri — Per la profildtsi sifilitica 
in rapporto all' allattamento 
degli esposito — Gior. ital. d. 
mal. ven.. Milano, 1000. xli, 538- 
544. 

Simionscou, F. — Un cas de chancre 
simple du pharynx — Bull, de 
laryngol, otol. et rhiuol., Pa: is, 
1909, xii. 2o-2i. 

Simmonds — Diagnostischer wert des 
spirochatenbefundes bei syphilis 
congenita — Deutsche med. 
Woch., Leipz. u. Berl., 1900, 
xxxii. 1721. 

Simmonds, M. — Ueber den diagnos- 
tischen wert des spirochaten- 
nachweises bei lues congenita — 
Miinchen med. Woch., 1906, liii, 
1302-1304. 

Simmonds, M, — Die thymus bei kon- 
genitaler syphilis — Virchow's 
Archiv f. patn. .mat.. Berl., 

1908, cxciv, Beihft, 213-224, 
lpl. 

Simon, C. — Diagnostic entre les 
syphilides psoriasiformes et la 
psoriasis par le grattage meth- 
odique — Ann. d. mal. van., 
Paris, 1909, iv, 88-95. 

Simon, L. G. — Lymphome tubercu- 
leux chez une enfant heredo- 
syphilitique — Bull. Soc. de pe- 
d"iat., Paris, 1907, xxv, 426-431. 

Simon, L. G. — Lymphone tubercu- 
leux chez une enfant heredo- 
syphilitique — Ann. de med. et 
c'hir. inf., Paris, xi, 835-841. 



Simonelli, F. — La spirochaete pal- 
lida nella milza degli eredosifi- 
litici — Atti. d. r. Accad. d. fis- 
ocrit. in Siena, 1906, 4 s. xviii, 
491. 

Simonelli, F. — Sul valore patogno- 
monico della spirochete pallida 
bella diagnosi della sifilide ex- 
tra-genitale — Gazz. d. osp., 
Milano, 1906, xxvii, 1486. 

Simonelli, F. e Bandi, L. — Di un 
metodo rapido di colorazione 
della spirochete pallida — Gazz. 
d. osp., Milano, 1905, xxvi, 
1103. 

Simonelli, F. u. Bandi, I. — Ueber 
eine rasche farbungsmethode 
von spirochaete pallida — Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena. 1905-6. xl. 159-162. 

Simonelli, E. e Bandi. I. — Ricerche 
sperimentali Bulla sifilide — 
Gazz. d. osp., Milano, 1906, 
xxvii, 27. 

Simonelli. F. u. Bandi, I. — Experi- 
mentelle untersuchungen ueber 
syphilis — Arch. f. Dermat. u. 
Svph., Wien u. Leipz., 1906, 
lx'xix, 209-212, 1 pi. 

Simonelli. F. — Su gli effetti dell' 
inoculazione di prodotti sifilit- 
ici nella cornea del coniglio — 
Gior. ital. d. mal. ven., Milano, 

1908. xlix, 213-216. 
Simonelli, F. — Contributo alio studio 

della sifilide ignorata — Atti. 
d. r. accad. d. fisiocrit. in Siena, 

1909, 5 s. i, 129-135. 
Simpson, F. E. — The timely recog- 
nition of syphilis — Med. Exam, 
and Pract.', N. Y., 1908, xviii, 
280. 

Sinclair, F. C. — Diagnosis of syph- 
ilis — South African M. Rec, 
Cape Town, 1906, iv, 116. 

Sinha. T. R. D.— A case of syph- 
ilitic fever of ten years' dura- 
tion ; treatment and recovery — 
Indian Lancet, Calcutta, 1905, 
xxvi, 411. 

Sisto. G. et Gaing, E.— Les cris dans 
l'heredo-syphilis — Clinique, 
Brux.. 1908, xxii, 27-31. 

Smazin, V. — Toxines and immuniz- 
ing substances in syphilis — 
Med. priba. v. k. morsk. sbor- 
niku. St. Petersb., 1907, pt. 2, 
159-164. 

Smith, J. S. — Syphilis — Northwest 
Med., Seattle, 1907, v, 83. 



Recent Bibliography. 



393 



Smith — A case of initial lesion of 
the lip — J. Cutan. Dis. incl. 
Syph., N. Y., 1907, xxv, 38. 

Smith, A. D. — Symptomatology 
and diagnosis of inherited 
syphilis — Pediatrics, N. Y., 
1909, xxi, 67-77. 

Smith, G. E.— The alleged discov- 
ery of syphilis in prehistoric 
Egyptians — Lancet, Lond., 
1908, ii, 521-524. 

Smithies, P, and Cummings, J. G. 
— The blood serum tests for 
syphilis, with practical consid- 
eration of the Wassermann re- 
action — Physician and Surg., 
Detroit and Ann Arbor, 1909, 
xxxi, 153-165. 

Snell, S. — Syphilis communicated 
by industrial implements — 
Brit. M. J., Lond., 1908, ii, 
1678. 

Snydaeker, E. F. — Involvement of 
the eye in syphilis — Illinois M. 
J., Springfield, 1906, ix, 415- 
422. 

Sobernheim, H. G. u. Tomasczewski, 
E. — Ueber spirochete pallida — ■ 
Miinchen med. Woch., 1905, lii, 
1857. 

Sobernheim, W. — Ein beitrag zur 
kenntnis der fieberhaften ter- 
tiarsyphilitischen organerkrank- 
ungen — Therap. d. Gegenw., 
Berl., 1905, xlvi, 486. 

Solger, F. B. — Die syphilisforschung 
und das vererbungsproblem — 
Dermat. Centralbl., Berl., 1905, 
viii, 290-298. 

Solger, F. B. — Die ziele der syph- 
ilisforschung in bezug auf die 
vererbungslehre — Dermat. Cen- 
tralbl., Leipz., 1906, ix, 290-296. 

Solger, F. B. — Die biologie der ver- 
erbung und ihre bedeutung fur 
die syphilisforschung — Dermat. 
Ztschi-., Berl., 1906, xiii, 555- 
560. 

Solger, F. B.— Weitere beitrage zur 
bedeutung des hautfarbstoffs 
nebst bemerkungen ueber leu- 
koderma syphiliticum — Dermat. 
Ztschr., Berl., 1907, xiv, 733- 
743. 

Solomonson, T. — Syphilis mortal- 
ity; statistical studies from the 
Insurance Company Le Dane- 
mark — Med. Exam, and Pract., 
N. Y., 1905, xv, 605. 



Sormani, B. P. — Het wezen en de 
waarde van de serodiagnostische 
reactie bij lues van Wasser- 
mann, Neisser en Bruck — Ge- 
neesk. Courant., Amst., 1908, 
Ixii, 343. 

Sormani, B. P.— Quantitative be- 
stimmung der luetischen ser- 
umveranderungen mittelst der 
reaktion von Wassermann-Neis- 
ser und Bruck — Arch. f. Der- 
mat. u. Syph., Wien u. Leipz., 
1909, xcvi'ii, 73-90. 

Le Sourd, L. et Pagniez, P. — Le 
spirochete pallida dans le sang 
des syphilitiques — Ann. de der- 
mat. et syph., Paris, 1907, 4 s. 
viii, 42. 

Le Sourd, L. et Pagniez, P. — La re- 
action precipitante du serum 
syphilitique vis-a-vis des solu- 
tions de glycocholate de soude 
— Compt. rend. soc. de biol., 
Paris, 1909, lxvi, 84. 

Le Sourd, L. et Pagniez, P. — Valeur 
diagnostique de la reaction de 
precipitation de Porges dans la 
syphilis — Gaz. d. hop., Paris, 
1909, lxxxii, 1597-1601. 

Sourotseff — Icterus syphiliticus — 
Med. pribav. k. morsk. sbor- 
niku, St. Petersb., 1905, 137. 

Soutzo Fils — Les nouvelles donnees 
relatives a la sero-reaction de 
la syphilis dans la paralysie 
generale par le methode de 
Wassermann — Ann. med-psy- 
chol., Paris, 1908, 9 s. viii, 52- 
68. 

De Souza, Jun u. Pereira, F. G. — 
Ueber das vorkommen von spi- 
rochete pallida bei acquirierter 
und congenitaler syphilis — 
Berl. klin. Woch., 1905, xlii, 
1385. 

Sovinski, Z. V. — Three cases of ex- 
tensive gummatous destruction 
upon the penis — Russk. j. 
kozhn. i. ven. boliezn, Kharkov, 
1905, x, 99-107. 

Sovinski, Z. V. — Patho-anatomical 
changes in gummatous syphilis 
— Russk. Vrach, S. Petersb., 
1905, iv, 1510. 

Sowinski, Z. — Pathologo-anatomical 
changes in the gummatous stage 
of syphilis — Prezgl lek, Kra- 
kow, 1906, xlv, 204. 



394 



Recent Bibliography. 



Bowinski, Z. — Several cases of ex- 
tensive chancres of the penis — 
Przgl. chorob skor i wen, Wars- 
zawa, 190fi. i, 241-252. 

De Speville — Le mercure gueri-t-il 
exclusivement les lesions d'or- 
igine syphilitique! — J. de med., 
Paris. 1007, 2 s. xix, 341. 

Spiegler. E. — Die behandlung der 
syphilis im friihstadium — Wien 
k'lin. Rundschau. 1008, xxii, 40. 

Spieler, F. — Ein hereditarleutisches 
miidchen mit symmetrischer 
lokaler asphyzie der unteren 
extremitaten und allgemeiner 
hautangioneurose — Mitt d. Ge- 
sellsch. f. inn. Med. u. Kinderh. 
in Wien, 1005. iv, 203. 

Spieler, F. — Osteoperiostitis luetica 
und exzessives langenqachstum 
der rechten tibia — Mitt. d. Ge- 
sellsch. f. inn. Med. u. Kinderh.. 
Wien. 1005. iv. 258. 

Spiethoff — Bericht ueber don der- 
zeitigen stand der syphilisfor- 
schung — Kor. Bl. d. allg. arztl. 
Ver. v. Thuringen. .Tena. 1007. 
xxxvi. 24-256. 

Spillmann. L. — Un nouveau mode 
de diagnostic microbiologiqne 
de la syphilis — Rev. med. de 
l'ouest. Nancy. 1000. xii, 392- 

Spillmann. L. — Deux cas de chan- 
cres syphilitiques multiples, un 
cas de chancre syphilitique du 
tronc gommes syphilitique au 
bout de 50 ans de syphilis, 
syphilides ulcereuses des jamlies 
chez une heredo-syphilitique — 
Rev. med. de l'ouest, Nancy, 
1008. xl. 715-717. 

Spillmann. L. — Troix cas de syph- 
ilis conjugale avec paralysie 
generate progressive consecutive 
— Prov. med.. Paris. 1908. xix. 
161-103. 

Spillmann. L. et Lamy — A propos 
du sero-diagnostic de la syph- 
ilis; interpretation d'une reac- 
tion negative chez un syphilit- 
ique — Compt. rend. Soe. de 
biol., Paris, 1998, lxiv, 561-563. 

Spillmann, L. — Considerations eur 
des lesions observees sur un 
crane de l'epoque merovin- 
gienne: ces lesions peuvent-elles 
etre attributees a la syphilis? — 
Compt. rend. soc. de biol., Paris, 
1908, lxiv, 753. 



Spillmann, L. — Un cas de syphilis 
conjugate — Rev. med. de l'ouest, 
Nancy, 1908, xl, 215. 

Spirt, L. — Un caz de hydarthrosa 
poliartieulara syphilitica (ter- 
tiara) — Spitalul, Bucuresci, 
1906, xx vi, 492. 

Spitzer, L. — Ueber spirochatenbe- 
funde im syphilitischen gewebe 
— Wien klin. Woch., 1905, xviii, 
822. 

Spitzer, L. — Zur atiologischen ther- 
apie der syphilis — Wien klin. 
Woch., 1905, xviii, 1171. 

Spitzer, L. — Weitere beitrage zur 
atiologischen therapie der 
syphilis — Verhandl. d. deutsch. 
d'ermat. Gesellsch., Berl., 1907, 
249-251. 

Splendore, A. — Sobre o treponema 
pallido de Schaudinn — Tribune 
med., Rio de Jan., 1908, xiv, 
37, 45, 102. 

Stadtler. J. — Ueber kiiochenerkrank- 
ung bei lues hereditaria tarda — 
Fortschr. a. d. geb. d. R8nt- 
genstrahlen, Hamb., 1907-8, xi, 
82-85, 1 pi. 

Stamm, C. — Erworbener partieller 
radiusdefekt bei einen heredi- 
tar leutischen sauglinge — Fort- 
schr. a. d. geb. a. Rontgenstrah- 
len, Hamb., 1908, xiii. 248, 1 pi. 

Stancanelli, P. — Deux cas de syph- 
ilis ignoree des formes vanes de 
phagcdenisme tertiaire — Ann. 
d. mal. ven.. Paris, 1909. iv, 
561-582. 

Stanziale, R. — Das treponema pal- 
lidum in der syphilitischen pla- 
centa — Centralbl. f. Bakteriol., 
1 Abt., Jena, 1909, xlix, Orig. 
551-553. 

Stark. M. M. — Gumma of the femur 
in a child — Am. Med.. Burling- 
ton. Vt. and N. Y„ 1909. ns. 
iv. 272. 

Starke, E. D. — Frequency of the ab- 
sence of skin lesions in syphilis 
— Virginia M. Semi-Month., 
Richmond. 1008-9, xiii, 448. 

Stauder. A. — Ueber luetischen leber- 
fieber — Arch. f. Verdaungskr., 
Berl.. 1908, xiv, 41-46. 

Steiner, G. — Orchitis luetica e ete 
case — Bor-es bujakorit, Buda- 
pest, 1905, 19. 

Steiner, G. — Interesting cases of 
late lues — Orvosi hetil Buda- 
pest, 1005, xlix, 552. 



Recent Bibliography. 



395 



Stelwagon — Papulo-tubercular syph- 
ilis a probable cause — J. Cutan. 
Dis. incl. Syph., N". Y., 1908, 
xxvi, 277. 

Stelwagon — A case of gumma of the 
lip — J. Cutan. Dis. incl Syph., 
N. Y., 1909, xxvii, 167. 

Stenczel, A. — Zwei falle von lues 
gummosa — Wien Klin. Woeh., 

1906, xix, 1536. 

Stenczel, A. — Untersuchungen ueber 
die spirochsete pallida in den 
krankheitsprodukten der erwor- 
benen syphilis — Wien klin. 
Woch., 1906, xix, 1586. 

Stephenson, S. — Two cases of infan- 
tile syphilitic keratomalacia in 
which an organism resembling 
the spirochete was found — 
Ophthalmoscope, Lond., 1907, v, 
142. 

Stephenson, S. — Etat actuel de la 
question du spirochete pallida 
dans les affections syphilitiques 
de 1'oeil — Clin, opht., Paris, 

1907, xiii, 227-229. 

Stern — Spirochsete pallida — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 1182. 

Stern — Neuinfektion bei bestehender 
tertiarer lues — Deutsche Med. 
Woch., Leipz. u. Berl., 1907, 
xxxiii, 123. 

Stern, A. — Remarks on congenital 
syphilis — Pediatrics, N. Y., 
1909, xxi, 89. 

Stern, C. — Untersuchungen zur 
pathogenese der anamie und zur 
funktionspriifung der leber bei 
syphilitikern — Deutsche med. 
Woch., Leipz. u. Berl., 1905, 
xxxi, 1104. 

Stern, C. — TJeber neuinfektion her- 
editarsyphilitischer und ueber 
reinfektion im allgemeinen — 
Dermat. Ztschr., Berl., 1907. 
xiv, 197-232. 

Stern, C. — Ueber die beeinfliissung 
syphilitischer erscheinungen 

durch nukleinhyperleukozytose 
—Med. Klin., Berl., 1907, iii, 
949-953. 

Stern, C. — Ueber einige bedenken 
gegen die Bauersche modifika- 
tion der Wassermannschen re- 
aktion— Berl. klin. Woch., 1909, 
xlvi, 497-500. 

Stern, M. — Zur teehnik der serodiag- 
nostik der syphilis — Berl. klin. 
Woch., 1908,' xlv, 1489. 



Stern, C. — Ueber die bewertung einer 
serum-farbenreaktion zum lues- 
nachweis — Berl. klin. Woch., 
1909, xlvi, 1068. 

Stern, M. — Ueber den nachweis der 
spirochsete pallida im ausstrich 
mittelst der silbermethode — 
Berl. klin. Woeh., 1907, xliv, 
400. 

Stern, Margarete — Eine vereinfach- 
ung und verfeinerung der sero- 
diagnostisehen syphilis reaction 
— Ztschr. f. Imniunitatsforsch. 
u. exper. therap., Jena, 1908-9, 
i, 422-438. 

Sternberg, C. — Gumma des fiinften 
halswirbels mit gummoser 
pachymeningitis — Mitt. d. Ge- 
sellsch. f. inn. Med. u. Kinderh., 
Wien, 1905, iv, 258. 

Sterling, W. — Syphilis of the man- 
dibular articulation — Gaz. lek, 
Warszawa, 1906, 2 s. xxvi, 751- 
753. 

Sterling, W. — Ein fall von syphilis 
der oberkiefergelenke — Monatsb. 
f. prakt. Dermat., Hamb., 1907, 
xliv, 559-561. 

Stevens, R. H. — Large, flat pustulo- 
crustaceous and pustular ulcer- 
ative syphiloderm — Med. Cen- 
tury, N. Y. and Chicago, 1907, 
xv, 73. 

Stewart, J. C. — Syphilis stimulation 
of malignancy — J. Minn. M. 
Ass. Minneap., 1908, xxviii, 137. 

Stiles, C. W. and Pfender, C. A.— 
The generic name (spironema 
vullemin. 1905 [not Meek 1864 
mollusk] micro-spironema Stiles 

Stoerk, O. — Ueber pankreasveriinder- 
ungen bei lues congenita — Cen- 
tralbl. f. allg. path. u. path, 
anat., Jena, 1905, xvi, 721-732, 
1 pi. 

Stolper, P. — Syphilis und unfall — 
Monatschr. f. Unfallheilk., 
Leipz., 1905, xii, 297-305. 

Stone, W. J. — The early diagnosis 
of syphilis and the technique of 
examination for the spirochete 
pallida— Med. Rec, N. Y., 1909, 
Ixxv, 638. 

Stone, W. J. — The technic of exam- 
ination for the pale spirochete 
by dark-field illumination — J. 
Am. M. Ass., Chicago, 1909, lii, 
960-962. 



396 



Recent Bibliography. 



Stoos — Ueber die bedeutung der 
Wassermannsehen seruindiag- 
nostik der syphilis hereditaria — 
Cor-Bl. f. schweiz. aerzte, Basel, 
1009, xxxix, 737-740. 

Stopczanski, J. — Beobaehtungen 
ueber die diagnose der syphilis 
vermittelst der Wasserruann- 
schen reaktion ■ — Wien klin. 
Woch., 1009, xxii, 1631-1637. 

Stout — Syphilis resembling derma- 
titis herpetiformis; a case — J. 
Cutan. Dis. incl. Syph., X. Y., 
1908, xxvi, 278. 

Stretton, J. L. — A case of congenital 
syphilis ; unusual symptoms — 
Brit. M. J., Lond., 1907, i. 140. 

Stritch — The state and syphilis — 
Tr. Roy. Acad. M., Ireland, Dub- 
lin, 1907, xxv, 448-471, 1 ch. 

Stritch — -The state and syphilis — 
Dublin J. M. Sc, 1907, cxxiv, 
222-227. 

Stritch, S. — Dentistry and syphilis 
—Brit. J. Dent.,' Lond., 1907-8, 
xxix, 389-398. 

Strominger, L. — Hypogastric syph- 
ilitic chancre — Spitalul, Bucu- 
resci, 1906, xxvi, 189-191. 

Stuart-Low, W. — Gumma ' of the 
mastoid region — Polyclin., 
Lond., 1908, xii, 91. 

Stucky, J. A. — Syphilitic manifesta- 
tions in naso-pharynx, ear and 
buccal cavity — Tr. Am. Laryn- 
golog. Rhin. and Otol. Soc, 
1905, St. Louis, 1906, xi, 282- 
285. 

Stiihmer, A. — Verwendung auto- 
lysierter lebern zu organ- 
extrakten fiir die Wasser- 
mann'sche reaktion — Zentralb. 
f. inn. Mod., Leipsic, April 2, 
1910, No. 14, s. 345-368, xxxi. 

Suarez, de Mendosa — Observation de 
causes anormales de transmis- 
sion de la syphilis — J. de la 
sante intime, Paris, 1906, 41-46. 

Sudhoff, K. — Ein neues syphilisblatt 
aus dem ende des 15 jahrhund- 
erts — Arch. f. Gesch. d. Med., 
Leipz., 1907-8, i, 374-382. 

Suggetts, O. L. — The possibilities of 
the spirochaeta pallida (trepo- 
nema pallidum) — Kansas City 
M. Index-Lancet, 1906, xxvii, 
325-327. 



Sutherland, G. A. — Some bone le- 
sions of congenital syphilis — 
Brit. J. Child. Dis., Lond., 1908, 
v, 52-54. 

Sutherland, G. A. — Inherited syph- 
ilis — Rep. Soc. Studv Dis. 
Child., Lond., 1908, vii, 175- 
176. 

Sutherland, W. D. — The sero-diag- 
nosis of syphilis — Indian M. 
Gaz., Calcutta, 1909, xliv, 201- 
204. 

Swellengrebel, X. H. — Sur la cyto- 
logic comparee des spirochetes 
et des spirilles — Compt. rend. 
Soc. de biol., Paris, 1907, Ixii, 
213. 

Swellengrebel, X. H.— Over spiro- 
chseten — Nederl. Tijdschr. v. 
Geneesk., Amst., 1909, i, 721- 
728. 

Swift, H. F. — A comparative study 
of serum diagnosis in syphilis 
— Arch. Int. Med., Chicago, 
1909, iv, 376-404. 

Swift, H. F. — The use of active and 
inactive serum in the comple- 
ment deviation test for syphilis 
— Arch. Int. Med., Chicago, 
1909, iv, 494-501. 

Swinburne, G. K. — A case of syph- 
ilitic reinfection— J. Cutan Dis. 
incl. Svph., X. Y., 1907, xxv, 
468. 

Swinburne. G. K. — Cases of syphilis 
insontium — Internat Dermat. 
Cong, vi, 1907, Tr., X. Y., 1908, 
ii, 827-830. 

Symanski, Hirschbruch u. Gardiew- 
ski — Luesnachweis durch far- 
benreaktion — Berl. klin. Woch., 
1909, xlvi, 874. 

Symposium on syphilis — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1906, x, 137, 179, 221, 
263, 305, 349, 409. 

Symposium on syphilis — J. Ophth. 
and Oto-Larvngol., Chicago, 
1909, iii, 183-192. 

Syphilis among the conquerors of 
Mexico (Edit.)— Brit. M. J., 
Lond., 1906, ii, 886. 

Syphilis in Uganda (Edit.) — Lan- 
cet, Lond., 1908, ii, 1022. 

Szadek, K. — Gangraena spontanea 
syphilitica — Przegl chorob skor 
i'wen, Warszawa 1906, i, 33, 97. 

Szasz B. — Ein fall von sehr grossen 
gumma — Pest med-chir. Presse, 
Budapest, 1908, xliv, 854. 



Recent Bibliography. 



397 



Taege, K. — Die teehnik der Wasser- 
mann-Neisser-Brucksehen sero- 
diagnostik der syphilis — Munch- 
en med. Woeh., 1908, Iv, 1730- 
1733. 

Tanaka, T. — Zur spirochaetefarbung 
in dem syphilisgewebe (Japan- 
ese text) — Hifubyog kiu Hinio- 
kibyog Zasshi, Tokyo, 1906, vii, 
106-109. 

Tanaka, T. — The spirochete in the 
system of pregnant women — ■ 
Kokka Igaku Kwai Zasshi, 
Tokyo, 1906, 23-35. 

Tanaka, T. — Experiments on animals 
by inoculation with syphilis — 
Hifukwa kiu Hiniokikwa Zas- 
shi, Tokyo, 1907, vii, 408-414. 

Tanaka, T. — The connection between 
syphilitic exanthemata and ery- 
sipelas curative serum — Hifu- 
kwa kiu Hiniokikwa Zasshi, 
Tokyo, 1907, vii, 457-460. 

Tapia — Tin cas de syphilis tracheale; 
traeheoscopie myosite aigue con- 
secutive des masseters guerison 
— Arch, internat. de larnygol., 
Paris, 1906, xxii, 540-542. 

Taylor, G. G. and Mackenna, A. W. 
- — Three cases of extra-genital 
chancre — Med. Press and Circ, 
Lond., 1908, ns. Ixxxvi, 477. 

Taylor, R. W. — The prognosis of 
syphilis — Med. News, N. Y., 
1905, lxxxvii, 433. 

Taylor, R. W— Evolution of the 
initial lesion or lesions in suc- 
cessive crops (chancres syphilit- 
iques successif s ) — J. Cutan. 
Dis., inch Syph., N. Y., 1905, 
xxiii, 513-517. 

Taylor, R. W. — Does syphilis in 
some eases spontaenously abort 
in the primary stage? — Am. J. 
Surg., N. Y, 1906, xx, 321-325. 

Taylor, R. W. — Hereditary syphilis 
—N. York M. J., 1906, lxxxiii, 
224-232. 

Taylor, R. W. — The development of 
multiple and successive initial 
syphilitic lesions and the path- 
ology of syphilis — J. Cutan Dis. 
incl. Syph., N. Y, 1906, xxiv, 
401-415, 2 pi. 

Taylor, R. W.- — A contribution to 
heredosyphilology — N. Y. M. J., 
1907, Ixxxvi, 717-719. 



Taylor, R. W. — The evolution of in- 
tra-primary lesions of syphilis; 
successive chancres and prod- 
romal syphilides — Brit. M. J., 
Lond., 1906, ii, 844-847. 

Taylor, W. E. and Ballenger, E. G. 
— A preliminary report on the 
spirochssta pallida — J. Am. M. 
Ass., Chicago, 1905, vol. xlv, p. 
1497. 

Tedeschi, E. — Fenomeni di allergia 
nei sifilitici cutereazione sifilit- 
ica — Gazz. d. osp., Milano, 1908, 
xxix, 620-622. 

Tedeschi, G. — Sifilide constiuzionale 
endoarterite luetiea obliterante 
con emiplegia cardio-arterio- 
sclerosi diffusa pericardite 
plastica adesiva — Tommasi, Na- 
poli, 1905-6, i, 552-557. 

Terebinski, V. I. — On early super- 
ficial syphilitic ecthyma — 
Russk. j. kozhn. i. ven. boliezn, 
Kharkov, 1906, xii, 18-49. 

Terebinski, V. I. — Partially gray 
hair in syphilis — Russk. j. 
koxhn. i. ven. boliezn, Kharkov, 

1906, xi, 338-348. 
Terebinski, V. I. — Early superficial 

syphilitic ecthyma — Russk. j. 
kozhn. i. ven. boliezn, Kharkov, 

1907, xii, 18, 102, 175, 228, 288, 
384, 3 pi. 

Terra, F. — O espirochaete de Schaud- 
inn — Brazil-med., Rio de Jan., 
1906, xx, 5, 15. 

Terrien, F. — Syphilis et allaitement 
—J. de med. de Paris, 1908, 2 
s. xx, 69. 

Terrien, F. — Manifestations ocu- 
laires de la syphilis hereditaire 
—J. de med. int., Paris, 1909, 
xiii, 198. 

Terrien, F. — Manifestations ocu- 
laires de la syphilis hereditaire 
— Clinique, Paris, 1909, iv, 322- 
325. 

Terrien, F. — Manifestations ocu- 
laires de la syphilis acquise — 
Clinique, Paris, 1909, iv, 466- 
468. 

Testi, E. — Le recenti richerche sulla 
immunizazione verso la sifilide 
■ — Gior. med. d. r. esereito, 
Roma, 1905, liii, 279. 

Terzaghi, R. — Tentativi di trans- 
mission di sifilide nelle scim- 
mie — Policlin., Roma, 1905, xii, 
sez prat, 701-703. 



398 



Recent Bibliography. 



Texier, \ . et Malherbe, H. — Syphilis 
bucco-pharyngee chancres mul- 
tiples et successifs — Ann. d. 
mal. de l'oreille du larynx, etc., 
Paris, 1005, xxxi, 356-361. 

Texier, V. et Malherbe, H.— Syphilis 
bucco-pharyngee chancres mul- 
tiples et successifs — J. d. mal. 
cutan. et syph., Paris. 1905, 
xvii, 406-501* 

Thesing, C. — Kritische bemerkungen 
zur spirocha?te pallida bei syph- 
ilis — MUnchen med. Woch., 

1905, lii, 1337. 

Thorel, L. — Du prurit dans la syph- 
ilis — Arch. gen. de med., Paris, 

1906. i, 78-82. 

Theuveny — Leg dents chez le foetus 
et le nouveau-ne syphilitiques — 
Odontologie, Paris, 1907, 
xxxviii, 97-106. 

Thibierge, G. — Sur lea relations du 
vitiligo et de la syphilis — Ann. 
de dei-mat. et svpli.. Paris. 1905, 
4 6. vi. 128-140. 

Thibierge, <;.. Ravaut P. et LeSourd, 
L. — Etude de venereologic ex- 
perimentale. Le chancre simple 
experimental de la paupiere 
chez les singes macaques — Ann. 
de dermat. et syph., Paris, 1905, 
4 s. vi, 753-780, 1 pi. 

Thibierge, G. et Kavaut. P. — Etude 
de venerologie experimental ; 
inoculation de produits syphilit- 
iques au bord libre de la paup- 
iere chez les singes macaques — 
Ann. de dermat. et svph., Paris, 
1905, 4 s. vi, 575-594, 2 pi. 

Thibierge. G.. Ravaut P. et LeSourd, 
L. — Le spirochete pallida de 
Schaudinn et le diagnostic de la 
syphilis; etude de bacteriologie 
clinique et recherche experimen- 
tales — Bull, et mem. Soc. med. 
d. hop. de Paris, 1906, 3 8. xviii, 
383-401. 

Thibierge, G. et Ravaut. P. — La re- 
action palpebrale des signes 
macaques a 1'inoculation de pro- 
duits syphilitiques — Bull, et 
mem. Snc. med. d. hop.. Paris. 
1905. 3 s. xxii. 465. 

Thibierge — Le diagnostic differentiel 
du chancre syphilitique — Rev. 
gen. de clin. et de therap., 
Paris, 1905, xix, 803. 

Thibierge — Les pigmentations d'orig- 
ine syphilitique — Med. mod., 
Paris. '1906, xvii. 73. 



Thibierge, G., Ravaut P. et LeSourd, 
L. — Chancre simple experimen- 
tal de la paupiere chez le singe 
— Bull, et mem. Soc. de hop., 
Paris, 1905, 3 s. xxii, 472. 

Thibierge — Le diagnostic du chancre 
syphilitique et la syphilis ex- 
perimentale — J. de med. int., 
Paris, 1906, x, 9-11. 

Thibierge — Les accidents nerveux 
L'Kivrs dans la premiere annee 
de la syphilis — J. de med. int., 
Paris. 1906, x, 57-59. 

Thibierge, Ravaut et Burnet — Spiro- 
chete de Schaudinn et syphilis 
experimentale — Compt. rend. 
Soc. de biol., Paris, 1906, lx, 
298-300. 

Thiroloix — Classification des arter- 
ites syphilitiques hemiplegie 
d'origine syphilitique — Bull, 
med., Paris," 1907, xxi, 21. 

Thomsen. O. — Den makroskopiske 
undersogelse af navlesnorsbe- 
taendelsen ved syfilis. The mi- 
croscopic examination of in- 
flammation of the umbilical 
cord in syphilis — Bibliot. f. 
Laeger, Kobenh., 1906, 8 R„ vii, 
1-12, 1 pi. 

Thomas — Hypertrophic de la rate 
et la foie d'origine syphilitique 
— Clinique, Paris, 1907, ii, 665. 

Thomas. H. G. — Syphilis as seen by 
the eve, ear, nose and throat 
specialist— Calif. State J. M., 
San Fran., 1908, vi, 377-379. 

Thompson. J. H. — Shakespeare on 
syphilis — Lancet. Lond., 1908, 
ii, 917. 

Thomsen. O. and Chievitz, 0. — Spi- 
rochete pallida (trepenema pal- 
lidum) in congenital syphilis— 
Bibliot. f. Laeger. Kobenh., 

1906. s. R, vii. 157-164. 
Thomsen, O. — Den moderne syfilis- 

forskning — Hosp. Tid., Kobenh., 

1907. 4 R. xv. 739-755. 
Thomsen, 0. — Modern researches on 

syphilis — Hosp. Tid., Kobenh., 
1907, 4 R. xv, 771-802-826. 

Thomsen. O. — The significance of the 
Rontgen examination for the di- 
agnosis of latent congenital 
syphilis — Bibliot. f. Laeger, 
Kobenh., 1907, 8 R. viii, 69-91, 
1 pi. 

Thomsen, O. — Wassermannsche re- 
aktion mit milch — Berl. klin. 
Woch., 1909, xlvi, 2052-2055. 



Recent Bibliography. 



399 



Thomsen, 0. u. Boas, H. — Die Was- 
sermann'sche reaktion bei kon- 
genitaler syphilis — Berl. klin. 
Woch., 1909, xlvi, 539-542. 

Thrasher, A. B. — Primary syphilis 
of lips and tonsils — Lancet- 
Clinic, Cincin., 1907, ns. Iviii, 
317. 

Thrasher, W. — Patient with inno- 
cently acquired syphilis in a boy 
of thirteen — Lancet-Clinic, Cin- 
cin., 1905, ns. lv, 75. 

Tibbals, F. B. — The transmission of 
syphilis — J. Mich. M. Soc, De- 
troit, 1908, vii, 456. 

Tiedemann, E. F. — The spirochete 
pallida and its demonstration in 
sections — Quart. Bull. M. Dep. 
Wash Univ., St. Louis, 1905-6, 
iv, 264-268. 

Tissier, L. et Girauld — Syphilis con- 
genitale — Bull. Soc. d'obst. de 
Paris. 1908, xi, 2-8. 

Tissier et Girauld — Heredo-syphilis 
et maceration foetale — Bull. 
Soc. d'obst. de Paris, 1908, xi, 
366-372. 

Tobler, L. — Ueber lymphozytose der 
cerebrospinalfliissigkeit bei kon- 
genitaler syphilis und ihre di- 
agnostiche bedeutung — Jahrb. f. 
Kinderh., Berl., 1906, lxiv, 1-25. 

Tobler, L. — Ueber lymphozytose der 
cerebrospinalfliissigkeit bei kon- 
genitaler syphilis und ihre di- 
agnostische bedeutung — Munch- 
en med. Woch., 1906, liii, 1890. 

Toepel — Die farbung der spirochsete 
pallida in schnitten uehersichts- 
referat — Dermat. Centralbl., 
Leipz., 1906, ix, 106. 

Tomasczewski, E. — Ueber den naeh- 
weis der spirochete pallida bei 
tertiarer syphilis — Miinchen 
med. Woch.,' 1906, liii, 1301. 

Tomasczewski, E. — Ein beitrag zur 
pathologie der syphilis — Arch, 
i. Dermat. u. Syph., Wien u. 
Leipz., 1907, lxxxv, 177-194. 

Tommasi, C. — A proposito di una 
propagine della sierodiagnosi 
nella sifilide — Riv. di patol. 
nerv., Firenze, 1909, xiv, 309- 
312. 

Torday, F. and Gyenes, V. — Serum 
diagnosis of congenital lues — 
Budapesti orv. ujsag, 1908, vi, 
379-384. 



Torok, L. — The results of the recent 

researches in syphilis — Gyogy- 

aszat, Budapest, 1907, xlviii, 

174, 194, 230. 
Torok, L. u. Schatteles, M.— Zur 

methode des nachweises der spi- 
rochete pallida — Pest. med. 

chir. Presse, Budapest, 1907, 

xliii, 845. 
Torres, H. — Quatro casos de sifilis 

que merecen alguna consider- 

acion — Bol. med. Lerida, 1905, 

iv, 621. 
Toscani, E. — Un caso di reinfezione 

sifilitica — Gior. d. r. accad. di 

med. di Torino, 1909, 4 s. xv, 

83-88. 
Toscani, E. — Un caso di reinfezione 

sifilitica — Corriere san., Milano, 

1909, xx, 356-358. 
Tourey-Piallat — Les nourrices ava- 

riees — Soc. franc, de prophyl. 

san. et mor. Bull., Paris, 1906, 

vi, 150-154. 
Tourey-Piallat — Les nourrices ava- 

riees — Clinique, Paris, 1906, i, 

88. 
Towle, H. P. — Primary lesion of the 

chin — J. Cutan. Dis. incl. Syph., 

N. Y., 1907, xxv, 311. 
Towle, H. P. — The serum diagnosis 

of syphilis — Boston M. and S. 

J., 1908, clix, 474, 502. 
Towle, H. P. — Hereditary syphilis— 

J. Cutan. Dis. incl. Syph., N. 

Y., 1908, xxvi, 271. 
Towle, H. P.— Syphilis? Post scab- 

etic eruption — J. Cutan. Dis. 

incl. Syph., N. Y., 1908, xxvi, 

472. 
Toyofuku, T. — Die veranderungen 

am ruckenmarke hereditarlueti- 

scher neugeborener — Arb. a. d. 

neurol. Inst. a. d. Wien Univ., 

Leipz. u. Wien., 1909-10, xviii, 

31-45. 
Toyosumi, H. — Ueber die komple- 

mentbindenden stoffe luetiseher 

sera — Centralbl. f. Bakteriol., 1 

Abt., Jena, 1909, li, 601-607. 
Toyosumi, H. — Ueber die natur der 

komplementbindenden stoffe bei 

lues — Wien klin. Woch., 1909, 

xxii, 747. 
Trantas, A. — Syphilis diagnostiquee 

par l'examen ophthalmoscopique 

— Gaz. med. d'orient, Constant., 

1905, i, 51. 



400 



Recent Bibliography. 



Trautmann, G. — Ueber einen fall 
von isoliertem lichen planus 
mucosae oris bei eineni luetiker 
—Dermat. Centralbl., Leipz., 
1909, xii, 100-107. 

Trcinski, T. — Prophylaxis of para- 
syphilitic processes — Medycyna 
Warszawa, 1905, xxxiii, 514, 
535, 557. 

Treumann — Ein fall von luetischen 
leberfieber — Miinchen med. 
Woch.. 1907, liv, 963. 

Trilla. R. L. — Un caso de goma sifi- 
litico en la base del craneo se- 
guido de comprobacion necrop- 
sica — Rev. balear de cicn med., 
Palma de Mallorca, 1906, xxviii, 
97-103, 113. 

Troisfontaine — Nolo sur an heredo- 
syphilitique de 12% ans — Ann. 
Soc. med-chir, de Liege, 1907, 
xlvi, 12. 

Troller, D. — Le diabete parasyph- 
ilitique — Gaz. med. de Paris. 
1907. 13. s. ii, 1. 

Truffi. M. — Ueber die uebertragung 
eines syphilitisclien primar- 
affektes auf die haul des kan- 
inchens — Centralbl. f. Bakteriol. 
1 Abt., Jena, 1008-9, xlviiii, 
Orig. 597-599. 

Truffi, M. — .Sulla transmissione 
della sifilide al coniglio — Bull, 
d. soc. med-chir. di Pavia, 1909, 
xxiii, 165-170. 

Truffi. M. — Transmissione della sifi- 
lide al coniglio — Biochem. e 
terap. sper., Milano, 1909, i, 
289-303. 

Truffi. M. — Transmissione della sifi- 
lide alia cute della cavia — 
Biochem. e. terap. sper., Milano, 
1909, i, 373-375. 

Tsatskin, A. V. — 'Chancre of the up- 
per lip — Russk. Vrach., S. 
Petersb.. 1908, vii, 939. 

Tscherniawski, W. A. — Ueber einen 
fall von osteochondritis und 
daetvlitis luotica hereditaria — 
Ztschr. f. orthop. Chir., Stuttg., 
1906, xvi, 306-321. 

Tschernogubow, N. — Eine einfache 
methode der serumdiagnose bei 
svphilis — Berl. klin. Wchnschr., 
1*908, xlv, 2107. 

Tschernogubow, N. A. — Zur frage 
von der anwendung aktiver sera 
fur die serumdiagnose bei svph- 
ilis— Berl. klin. Woch., 1909, 
xlvi, 1808-1812. 



Tschernogubow, N. A. — Zur frage 
der herstellung von syphiliti- 
sclien antigenen — Wien klin. 
Woch., 1909, xxii, 336-338. 

Tschernogubow, N. A. — Ein verein- 
fachtes verfahren der serumdi- 
agnose bei syphilis — Deutsche 
med. Woch., Leipz. u. Berl., 
1909, xxxv, 668. 

Tubby, A. H. — The bone and joint 
lesions in hereditarv svphilis — 
Brit. .T. Child. Dis., Lond., 1908, 
v, 49-52. 

Turchi, O. ■ — A propositi della siero- 
diagnosi della sifilide per mezzo 
di una reazione cromatica — -Riv. 
di patol. nerv., Firenze, 1909, 
xiv, 303-309. 



Uglotti, F. e Stanghellini. D.— Sul 
valore pratico di alcuni recenti 
metodi di sierodiagnosi della 
sifilide — Note e riv di psichiat., 
Pesaro, 1909, 3 s. ii, 167-174. 

Uhle, A. A. and Mackinney, W. H. — 
The demonstration of spiro- 
chseta pallida in lesions of ac- 
quired syphilis — J. Am. M. Ass., 
Chicago, 1907, xlviii, 605. 

Uhlenhuth u. Mulzer, P. — Ueber 
experimented kaninchensrvph- 
ilis mit besonderer beriicksich- 
tigung der impfsyphilis des 
hodens — Arb. a. d. k. Gsndts- 
amte, Berl., 1909, xxxiii, 183- 
200. 

Ullmann. J. — Ueber erkrankung des 
nebenhodens in friihstadium der 
syphilis — Monatsh. f. prakt. 
Dermat., Hamb.. 1905, xli, 10. 

Umbert — El pronostico de la sifilis 
— Rev. de med. v cirurg., Bar- 
cel., 1906, xx, 249-257. 

Umbert — El pronostico de la sifilis 
— Rev. espan. de dermat. y sif., 
Madrid. 1906, viii. 482-506. 

Umehara, S. — Pancreatic metabo- 
lism in acquired svphilis — 
Chiugai Iji Shinpo, Tokio, 1907, 
xxviii, 361-377, 1 pi. 

Upsanski, I. I. — Non-sexual infec- 
tion of the penis with svphilis 
—Vrach Gaz., S. Petersb.', 1906, 
xiii, S52. 

Uruena. J. G. — Chancros sifiliticos 
extragenitales — Bscuela de 
med., Mexico, 1909, xxiv, 366- 
369. 









Recent Bibliography. 



401 



Vaccari, A. — Le receuti scoperte 
( Siegel ) e spirochete pallida 
(Schaudhm) — Kassegna inter- 
naz. d. med. mod., Catania, 
1905, vi, 146, 155. 

Vaccari, A. — Le reeenti scoperte 
sulla etiologia della sifilide cy- 
torhyctes luis (Siegel) e spiro- 
chete pallida Schaudinn — Ri- 
vista sintetica, Ann. di med. 
nav., Roma, 1905, ii, 99-123. 

Vadam, P. — Les methodes de labo- 
ratorie appliquees a la clinique 
methodes bacterioscopiques con- 
firmant le diagnostic de la 
syphilis — Medeein prat., Paris, 
1908, lv, 293. 

Vadam, P. — Le diagnostic de la 
syphilis par 1'examen du sang 
— Medeein orat., Paris, 1909, 
v, 645-647. 

Del Valle, E. — Profllaxis de la syph- 
ilis — Bol. Assoc, med. de 
Puerto-Rico, San Juan, P. R., 
1905, iii, 5, 21. 

Vallentin, E. — Totaler nasenrachen- 
verschluss und lues maligna — • 
Arch. f. Dermat. u. Syph., Wien 
u. Leipz., 1906, lxxxix, 337-384. 

Vargas, M. — Investigacion colectiva 
sobre la sifilis — Meu. de los 
ninos, Barcel., 1909, x, 17-21. 

Variot — Accidents parasyphilitiques 
hereditaires chez l'enfant — J. de 
med. int., Paris, 1905, ix, 158. 

Variot — Syphilis hereditaire — J. de 
med. int., Paris, 1908, xii, 171. 

Varny, H. R. — The serum diagnosis 
of syphilis — Detroit M. J., 
1908, viii, 343-355. 

Vazquez, Elena L.— Un caso de 
chancro sifilitico de la conjunc- 
tiva bulbar — Rev. med. de Se- 
villa, 1908, li, 353-357. 

Vazquez, Liena L. — Algunas consid- 
eraciones sobre un caso de goma 
sifilitico ulcerado de la lengua 
— Rev. espan. de dermat. y sif., 
Madrid, 1909, xi, 333-335. 

Vedel et Delmas — Chancres syphilit- 
iques extra-genitaux — Montpel. 
med., 1906, xxiii, 618. 

Vedel — Chancres syphilitiquea suc- 
cessifs — Montpel. med., 1907, 
xxiv, 140. 



Veiel, F. — Zur infektiositat dea 
gumma — Arch. f. Dermat. u. 
Syph., Wien u. Leipz., 1901, 
Ixxxv, 225-230. 

Veillon, A. et Girard, J. — Spiro- 
chete pallida Schaudinn dans la 
roseole syphilitique — Compt. 
rend. soc. de biol., Paris, 1905, 
lix, 652. 

Veress, F. — Syphilis tertiraria 
precox ket esete — Bor-es buia- 
kort, 1906, 27. 

Veress, F. — The signs of congenital 
syphilis; especially the signifi- 
cance and essence of furrows of 
the cheeks which appear like 
light rays — Bor-es bujakort, 
Budapest, 1907,'l3-16, 1 pi. 

Veron et Payenneville — Un cas de 
syphilis malignee precoce — Nor- 
mandie med., Rouen, 1908, 
xxiii, 74-76. 

Verotti — Di un caso singolare di 
dermatite eritemato-nodosa sif- 
ilide ignorata — Gior. ital. d. 
mal. ven., Milano, 1906, xli, 
555. 

Verotti — Di un caso di sifiloderma 
papulo-squamosa miliare simu- 
lante la pitirasis rubra pilaris 
— Gior. ital. d. mal. ven., Mi- 
lano, 1906, xli, 560. 

Verotti, G. — Sur un cas singulier de 
dermatite erythematonoueuse 
due a une syphilis ignoree — 
Ann. de mal. ven., Paris, 1907, 
ii, 339-356. 

Verrotti — Di un caso di sifiloderma 
papulo-squamosa miliare simu- 
lante lapirirasis rubra pilaris — 
Gior. ital. d. mal. ven., Milano, 
1907, xlii, 5-11, 1 pi. 

Verrotti, G. — Di alcuni casi di 
febbre sifilitica tardiva con vis- 
ceropatie specifiche non comuni 
— Gior. internaz. d. sc. med., 
Napoli, 1908, ns. xxx, 721-736. 

Verse, M. — Die spirochete pallida 
in ' ihren beziehungen zu den 
syphilitischen gewebsverander- 
ungen— Med. Klin., Berl., 1906, 
ii, 653-682. 

Versilova, Mme. M. A. — On the pas- 
sage of syphilitic spirochete 
from mother to child — Russk. 
Vrach, S. Petersb., 1906, v, 757- 
759. 



402 



Recent Bibliography. 



Verstraeter, C. — La morsure du 
culex pipiens ne transmet pas 
la syphilis — Bull. Soc. de med. 
de Cand., 1905, lxxi, 227. 

Veszpreini, D. and Kanitz, H. — Se- 
rious liver trouble in the period 
of secondary syphilis — Orvosi 
hetil, Budapest,' 1907, li, 852- 
888. 

Vignolo-Lutati, C. — Intorno ad un 
caso raro di pachionissi sifilit- 
ica totale — Gazz. med. ital., To- 
rino, 1908, lix, 51-53. 

Vignolo-Lutati, C. — -Sulla tifosi sif- 
ilitica — Gazz. med. ital., To- 
rino, 1908. lix. 101-104. 

Vilanova, P. — Epidemia de estoma- 
titia mercurial — Rev. de cien. 
med. de Barcel., 1905, xxxi, 545- 
547. 

Vilanova, P. — La sifilis en Barce- 
lona—Rev. de med. y cirurg., 
Barcel., 1907, xxi, 33." 

Villemin — L'osteite syphilitique 
hereditaire — Rev. gen. de clin. 
et de therap., Paris, 1908, xxii, 
97-99. 

Vitrac, J. — Syphilis et accident du 
travail inoculation primi- 
tive (?) au niveau d'une plaie 
du medicos — Gaz. hebd. d. sc. 
med. de Bordeaux, 1908, xxix, 
615-617. 

Voloshin, A. D. — Syphilitic aortitis 
— Obozr. Mosk.'Med., 1905, lxiv, 
463-476. 

Voloshin — Syphilitic aortitis — Med. 
pribav k morsk sborniku, St. 
Petersb., 1906, 131. 

Voloshin. A. D.— On the micro-or- 
ganism of syphilis — Russk. 
Vrach. S. Petersb., 1906, v, 
1210-1212. 

Volpino, G. — Sulla colorazione delle 
spirochete delle sozteni di or- 
gani sifilitici — Gior. d. r. Accad. 
di med. di Torino, 1905, 4 s. xi, 
733-735. 

Volpino, G. u. Fontana, A. — Einige 
voruntersuehungen ueber kiinst- 
liche kultivierung der spiro- 
chete pallida (Sehaudinn) — 
Centralbl. f. Bakteriol., 1 Abt., 
Jena, 1906, xlii, 666. 

Volpino, G. e Fontana, A. — Ri- 
cherche preliminari d'orienta- 
mento sulla coltivazione arti- 
ficiale della spirochete pallida 
(Sehaudinn) — Riv. d'ig. e san 
pubb., Torino, 1906, xvii, 402- 
466. 



Volpino, G. — Osservazioni alia crlt- 
ica di Saling relativa alle im- 
agini di spirocheti che si otten- 
gono nei tessuti con l'impiego 
del metodo fotografico — Riv. 
d'ig. e san, pubb., Torino, 1907, 
xviii, 270-276. 

Volpino, G. — Zur farbung der spi- 
rochete pallida — Deutsche med. 
Woch., Leipz. u. Berl., 1907, 
xxxiii, 151. 

Vomer, H. — Ueber syphilis und 
hamorrhagie — Arch. f. Dermat. 
u. Svph., Wien u. Leipz., 1905, 
lxxvi, 55-64, 1 pi. 

Vomer, H. — Ueber schmerzhafte 
drusenschwellung bei lues — 
Miinchn. med. Woch., 1906, liii, 
16-23. 

Vomer, H. — Ueber wechselndes vor- 
kommen der lues spirochate — 
Munchen med. Woch., 1907, liv, 
2330. 

Vomer, H. — Ueber nagelpigmenta- 
tion bei sekundarer syphilis — - 
Miinehen med. Woch., 1907, liv, 
2483. 

Vomer, H. — Verdeckte syphilisstel- 
len — Mttnchen med. Woch., 
1909, lvi, 718. 

Vomer, H. — Zum leucoderma syph- 
iliticum — Arch. f. Dermat. u. 
Syph., Wien u. Leipz., 1909, 
xcvii, 203-210. 

Vuillemin. P. — Sur la denomination 
de 1'agent presume - de la syph- 
ilis — Compt. rend. Accad. d. sc. 
Paris, 1905, exl, 1567. 



W 

C. W. W. — A case of chancre of the 
lower eyelid — Guy's Hosp. Gaz., 
Lond., i906, xx, 484. 

Wachenfeld. A. — Haemorrhagische 
queeksilberreaktion bei friihlues 
—Dermat. Ztschr., Berl., 1909, 
xvi, 29-31. 

Waelsch, L. — Bemerkungen zu der 
mitteilung von Professor L. 
Merle ueber den cvtoryktes luis 
(Siegel) — Wien klin". Woch., 

1905, xviii. 1055. 

Waelsch, L. — Des planus inflamma- 
tus syphiliticus nebst bemerk- 
ungen zur wirkung des jod ter- 
tiar-syphilitische krankheits- 
prozesse — Prag. med. Woch., 

1906, xxxi, 525-527. 



Recent Bibliography. 



403 



Waelsch, L. — Ueber syphilis d'em- 
blee und die berufssyphilis der 
aerzte — Miinchen med. Woch., 
1909, lvi, 850-853. 

Waldo, H— Syphilis— Bristol M- 
Chir. J., 1907, xxv, 289-304. 

Waldo, H. — Notes on syphilis — 
Med. Press and Circ, Lond., 
1908, ns. lxxxv, 8-11. 

Waldvogel u. Sussenguth — Die fol- 
gen der lues statistische erbeb- 
ungen— Berl. Win. Woch., 1908, 
xlv, 1213-1218. 

Walker, N. — Exera-genital chancre 
— Tr. Med-Chir. Soc, Edinb., 
1906, ns. xxv, 125. 

Wall, J. S. — Hereditary syphilis — 
Am. J. Obst., N. Y., 1908, lvii, 
890-891; Discussion 857. 

Wallhauser — Neglected syphilis — J. 
Cutan. Dis. incl. Syph., N. Y., 
1908, xxvi, 468. 

Wallich, V. — Rapport sur une ob- 
servation de M. M. Sauvage et 
C. Levaditi intitulee; sur un 
cas de syphilis hereditaire — 
Rev. prat, d'obst. et de paediat., 
Paris, 1906, xix, 17-25. 

Wallich, V. et Levaditi, C— Re- 
cherches sur la presence du spi- 
rochete pallida dans le placenta 
— Compt. rend. Soc. de biol., 
Paris, 1906, lx, 191. 

Wallin, C. C. — Diagnostic difficul- 
ties due to syphilis — Am. J. 
Dermat. and Genito-Urin. Dis., 
St. Louis, 1908, 242-244. 

Wanner- — Funktionsprufungen bei 
kongenitaler lues — Verhandl. d. 
deutsch. otol. Gesellsch., Jena, 
1908, 98-108. 

Ware, M. W. — Radiographs of syph- 
ilis of the long bones — Arch. 
Roentg. Ray, Lond., 1907-8, xii, 
343. 

Ware, M. W.— Radiograms of syph- 
ilis of the long bones — Inter- 
nal Dermat. Cong. Tr., N. Y., 
1908, ii, 809. 

Ware, M. W. — Radiograms of syph- 
ilis of the long bones — Surg. 
Gynee. and Obst., Chicago, 1908, 
vi, 9-14. 

Warfield, L. M. — Syphilis heredi- 
taria tarda; report of a case — 
Arch. Pediat, N. Y., 1905, xxii, 
927. 

Warrington, W. B. — Visceral syph- 
ilis — Liverpool M-chir. J., 1909, 
xxix, 87-100. 



Warrington, W. B. — Visceral syph- 
ilis — Med. Press and Circ, 
Lond., 1909, lxxxviii, 219-222. 

Van Wart, R. M. — A case of mus- 
culo-spiral paralysis resulting 
from a syphilitic periostitis of 
the humerus — N. Orl. M. and 
S. J., 1909-10, Ixii, 34. 

Washburn, P. H. — Extra-genital pri- 
mary syphilis; a report of six 
cases occurring in country prac- 
tice — J. Cutan. Dis. incl. Syph., 
N. Y., 1907, xxv, 300-302. 

Wassermann, A., Neisser, A. u. 
Bruck, C. — Eine serodiagnos- 
tische reaktion bei syphilis — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 745. 

Wassermann, A. — Ueber das vorhan- 
densein syphilitischer antistoffe 
in der cerebrospinalfliissigkeit — 
Deutsche med. Woch., Leipz. u. 
Berl., 1906, xxxii, 1769-1772. 

Wassermann, A. — Weitere mitteil- 
ung ueber den nachweis spezi- 
fischluetischer substanzen durch 
komplementveranderung — Zts- 
ehr. f. Hyg. u. Infektions- 
krankh, Leipz., 1906, Iv, 451- 
477. 

Wassermann, A. u. Meier, G. — Zur 
klinischen verwerting der se- 
rumdiagnostik bei lues — 
Deutsche med. Wchnschr., 
Leipz. u. Berl., 1907, xxxiii, 
1287-1289. 

Wassermann, A. — Ueber die entwick- 
lung und den gegenwartigen 
stand der serodiagnostik gegen- 
iiber syphilis — Berl. klin. 
Woch., 1907, xliv, 1599, 1634. 

Wassermann, A. — Ueber die serodi- 
agnostik bei syphilis — Wien 
klin. Woch., 1908, xxi, 3S8. 

Wassermann, A. — Ueber die serodi- 
agnostik der syphilis und ihre 
praktische bedeutung fur die 
medizin — Wien klin. Woch., 
1908, 745-748. 

Wassermann, A. — Ueber die serodi- 
agnostik der syphilis und ihre 
praktische bedeutung ftir die 
medezin — Heilkunde, Berl., 
1908, xxi, 745-748. 

Wassermann, A. — Ueber die sero- 
diagnostik der syphilis und ihre 
praktische bedeutung fur die 
medizin — Verhandl. d. Kong. f. 
innere Med., Wiesb., 1908, xxv, 
181-191. 



404 



Recent Bibliography. 



Watabiki, T.— A study of the blood 
in syphilis — Am. Med., N. York 
and"Phila., 1907, ns. ii, 225-231. 

Yon Watraszewski — Ueber einige 
seltene svphilisfiille — Allg. med. 
Centr. Ztg., Berl., 1908, lxxxvii, 
47. 

Yon Watraszewski — Ueber einige 
seltene svphilisfalle — Allg. med. 
Centr-Ztg., Berl.. 190S, Ixxvii, 
92, 107, 151. 

Von Watraszewski — Ueber svphilis- 
falle ohne rechtzeitige hauter- 
scheinungen — Allg. med. centr- 
ztg., Berl., 1909, lxxviii, 89, 105. 

Watson, H. G. — Syphilis communi- 
cated in assault and battery — 
N. York M. J., 1908, lxxxviii. 
204. 

Weaver, J. S. — Gumma of external 
nose — T. Kansas M. Sue. Kan- 
sas City, Kan., 1909. ix, 17-19. 

Weber. F. P. — On tertiary syphilitic 
fever and the visceral and other 
changes connected with it — 
Lancet, Lond., 1907, i, 728-731. 

Weber, F. P. — A note on congenital 
syphilitic osteitis deformans — 
Brit. J. Child. Dis.. Lond., 1908, 
v, 83-86. 

Weber, H. C. — Primary secondary 
svphilis — Am. Pract. and News, 
Louisville. 1906. xl. 118-128. 

Weber. L. — Syphilis and longevity — 
Am. ,T. Dermat. and Genito- 
Urin. Dis., St. Louis, 1906, x. 
323. 

Wechselmann, W. u. Loewenthal. W. 
— L'ntersuchimgen ueber die 
Schaudinn-Hoffmann'schen spi- 
rochatenbefunde in syphilitschen 
krankheitsprodukten — Med. 
Klin.. Berl.. 1904. i, 657. 

Wechselmann, W. u. Loewenthal. W. 
— Zur kenntnis dor spirochete 
pallida — Med. Klin.. Berlin. 

1905. Bd. i. 838. 
Wechselmann — Bemerkungen zu den 

frflher vorgestellten fallen von 
erythrodermia exfoliativa pseu- 
doleucaemica und von erythema 
nodosum im verlaufe von syph- 
ilis — Dermat. Ztschr.. Berl.. 

1906. xiii, 657-659. 
Wechselmann — Experimenteller 

beitrag zur kritik der Siegel- 
schen syphilisiibertragungsver- 
suche — Deutsche med. Wchn- 
schr., Leipz. u. Berl.. 190fi, 
xxxii, 219. 



Wechselmann — Postkonzeptionelle 
syphilis und Wassermann'sehe 
reaktion — Deutsche med. Woch., 
Leipz. u. Berl., 1909, xxxv, 665- 
668. 

Weichselbaum. A. — Ueber die aeti- 
ologie der svphilis — Wien med. 
Wchschr., 1906, lvi. 361-364. 

Weil, A.- — Ueber den lues-antikorp- 
ernachweis im blute von luet- 
ischen — Wien klin. Woch., 1907, 
_xx, 527-531. 

Weil, A. — Lin cas de manifestations 
articulaires ayant simule le 
rhumatisme articulaires aigu 
au cours d'une syphilis second- 
are — Ann. d. mal. ven., Paris, 
1908, iii, 291-294. 

Weil, E. u. Braun, H. — LTeber anti- 
korperbefunde bei hies tabes 
und paralyse — Berl. klin. Woch., 

1907. xliv'. 1570-1574. 

Weil, E. u. Braun, H. — Ueber die 
entwicklung und den gegen- 
wartigen stand der serodiagnos- 
tik gegentiber syphilis — Berl. 
klin. Woch.. 1907. 'xliv, 1682. 

Weil, E. u. Braun, H. — Ueber die 
entwicklung der serodiagnostik 
bei lues — Wien klin. Woch., 

1908. xxi, 624. 

Weil, E. u. Braun. H. — L T eher posi- 
tive Wassermann-Neisser-Bruck- 
sche reaktion bei niohtluetischen 
erkrankungen — Wien klin. 
Woch.. 1908, xxi. 938-940. 

Wei], E. u. Braun. H. — Ueber das 
wesen der luetischen erkriink- 
ung auf grund der neueren for- 
schungen — Wien klin. Woch., 

1909. xxii, 372-374. 

Weil. R. — On the variation in the 
resistance of human erythro- 
cytes in disease to hemolysins 
with especial reference to syph- 
ilis — Proe. Soc. Exper. Biol, and 
Med.. N. Y.. 1909-10, vii. 2-5. 

Weimer. E. A. — Diagnosis of syph- 
ilis, its importance and its dif- 
ficulties — Am. J. Dermat. and 
Genito-Urin. Dis., St. Louis, 
1908. xii. 339-342. 

Weiner. M. — A very rare case of ex- 
tra-genital infection of syphilis 
— Bor-es bujakort. Budapest. 
1907, 42. 

Weis, J. D. — A rapid method of 
demonstration of the spiro- 
cha^ta pallida for diagnosis — N. 
Orl. M. and S. J., 1907-° "- 
561-567. 



Recent Bibliography. 



405 



Weis, J. D. — A rapid method of 
demonstration of the spirochseta 
pallida for diagnosis — N. Orl. 
M. and S. J., 1908, lxi, 205-210. 

Weiss, L. — Syphilis in children — N. 
York State J. M., N. Y., 1907, 
vii, 433-438. 

Weitlander, F. — Noch einiges ueber 
spirochete pallida — Berl. klin. 
therap. Woch., 1905, 1124-1129. 

Weitz, W. — Ueber einen eigenarti- 
gen fall von syphilis haemor- 
rhagica bei einen erwachsenen — 
Monatsh. f. prakt. dermat., 
Hamb., 1905, xli, 544-554. 

Welander, E. — Wie kbnnen wir die 
soziale gafahr die hereditar- 
syphilitische kinder verursachen 
bekampfen ? — Mitt. d. deutsch 
Gesellsch. z. Bekampf d. Ge- 
schlechtskr., Leipz., 1908, vi, 
110-125. 

Welander, E. — Ueber die reaktion 
der syphilitischen hautaffekt- 
ionen (besonders des Roseols) 
gegen die erste einfiihrung von 
queeksilber in den organismus — 
Arch. f. dermat. u. syph., Wien 
u. Leipz., 1909, xcv, '75-106. 

Wellman, F. C. — On the morphology 
of the spirochete found in yaws 
papules — Arch. f. Schiffs u. 
Tropen Hyg., Leipz., 1907, xi, 
545-547. 

Welt-Kakels, Sara — Ein fall von 
gummoser schadelsyphilis bei 
einem 2% jahrigen idiotischen 
knaben — N. Yorker med. Monat- 
schr., 1905, xvi, 531-533. 

Welt-Kakels, Sara — Cranial gum- 
matous syphilis in an idiotic 
boy— Arch. Pediat., N. Y., 1906, 
xxiii, 126-128. 

Wernic, L. — Technique of Wasser- 
mann's method of diagnosing 
syphilis and the precipitate test 
with the destruction of the alex- 
ins, and glycocholate of soda — 
Gaz. lek., Warszawa, 1909, 2s. 
xxix, 99, 135. 

Wersilowa, Marie — Zur lehre der 
hereditaren syphilis — Centralbl. 
f. Bakteriol., 1 Abt., Jena, 1906, 
xlii, 513-518. 

Westphalen, H. — Ueber fieber bei 
viszeraler syphilis — St. Petersb. 
med. Woch., 1906, xxxi, 440-453. 

Weyl, B. — Grosshirnbefunde bei 
hereditarysyphilitischen saug- 
lingen — Jahrb. f . Kinderh., 
Berl., 1908, lxviii, 444-461. 



White, B. and Avery, O. T. — The 
treponema pallidum ; observa- 
tions on its occurrence and dem- 
onstration in syphilitic lesions 
— Arch. Int. Med., Chicago, 
1909, iii, 411-421. 

White, W. H. — The clinical aspects 
of visceral syphilis — Med. 
Chron., Manchester, 1906-7, xliv, 
135-141. 

Whitehouse — Affection of the nails. 
Hereditary syphilis — J. Cutan. 
Dis. incl. Syph., N. Y., 1908, 
xxvi, 461-462. 

Whiteside, G. S. — Maternal syphilis 
— J. Am. M. Ass., Chicago, 1905, 
xlv, 1065. 

Whitfield, A. — Specimens ifrom a 
ease of syphilis — Proc. Roy. Soc. 
Med., Lond., 1907-8; i Dermat. 
Sect. 172-174. 

Whitfield, A. — 'Case of secondary 
syphilis in a man, exhibiting 
some unusual features of the 
eruption — Proc. Roy. Soc. Med., 
Lond., 1908-9; Dermat. Sect. 76. 

Whittmore, W. — The Wassermann 
reaction for syphilis — Boston 
M. and S. J., 1909, clx, 651. 

Wickersheimer, E. — La question des 
origines de la syphilis — France 
med., Paris, 1907, liv, 443-445. 

Widal, F. — La lymphocytose rachi- 
dienne dans la syphilis — Rev. 
gen. de clin. et de therap., Paris, 
1906, xx, 468. 

Widal — La lymphocytose dans la 
syphilis — J. de med. et chir. 
prat., Paris, 1907, lxxviii, 14. 

Widal, E. et Weill, A. — Sporotrich- 
ose gommeuse disseminees a noy- 
aux tres confluents gommes 
dermiques pour la plupart 
gommes hypodermiques et in- 
tra-musculaires gomme sous- 
periostee tibiale; presence du 
parasite dans le sang — Bull, et 
mem. soc. med. d. hop., Paris, 
1908, 3 s. xxv, 944-947. 

Wieder, H. S. and L'Engle, E. M.— 
Some studies of the precipitin 
tests for syphilis — J. Am. M. 
Ass., Chicago, 1909, liii, 1535- 
1537. 

Wiens — Spirochaetenuntersuchungen 
an Chinesen — Arch. f. Schiffs u. 
Tropen-Hyg., Leipz., 1906, x, 
459-462. 



406 



Recent Bibliography. 



Wiesner, R. — Ueber erkrankung der 
grossen gefasse bei lues congen- 
ita — Centralbl. f. allg. path. u. 
anat., Jena, 1905, xvi, 822. 

Wiggs, L. B. — Syphilis of bone and 
joints — Old Dominion J. M. and 
S., Richmond, 1908-9, vii, 1-13. 

Wild, R. B. — Some clinical aspects 
of syphilis — Brit. J. Dermat., 
Lond*., 1906, xviii, 161-177. 

Wile, U. J.— Comparative experi- 
ments on the presence of com- 
plement binding substances in 
the serum and urine of syphilit- 
ica — T. Am. M. Ass., Chicago, 

1908, li, 1142. 

Wile. W. J. — The spirochaeta pallida, 
its easy demonstrability and a 
brief review of its history — J. 
Cutan. Dis. incl. Svph., N. Y., 

1909, xxvii, 296-303. 
Williams, A. U. — Some cases of re- 
infection with svphilis — Lancet- 
Clinic, Cincin., 1908. c, 178. 

Williams, A. U. — Some cases of re- 
infection with svphilis — Med. 
Fortnightly, St. "Louis, 1907, 
xxxii, 485. 

Williams. C. E. — The contagiousness 
of gumma — Med. Rec., N. Y., 
1906, lxx, 45-52. 

Williams, C. M. — Four cases of 
chancre of the lip — Med. Rec, 
N. Y., 1905, lxvii, 290. 

Williams. C. M. — Some results which 
have been obtained in the ex- 
perimental inoculation of syph- 
ilis — J. Cutan. Dis. incl. Svph., 
N. Y., 1907, xxv, 350-356. 

Williams, R. — Syphilis: extra-geni- 
tal chancres — South Calif. 
Pract., Los Angeles, 1905, xx, 
546. 

Williams, R. — Syphilis; extra-geni- 
tal chancres — Calif. State J. 
M., San Fran., 1907, v, 307-309. 

Wilmot, T. J. T — Ocular manifesta- 
tions of svphilis — Dublin J. M. 
Sc, 1908, "cxxv, 339-346. 

Wilson, D. S. — Diagnostic import- 
ance of the spirochete pallida or 
treponema pallidum — Louisville 
Month. J. M. and S., 1908, xv, 
69-72. 

Wilson, F. P. — The serum diagnosis 
of syphilis — Liverpool M. Chir. 
J., 1909, xxix, 381-396. 

Wilson, W. R. — Hemorrhage of syph- 
ilitic origin in the newborn — 
Arch. Pediat, N. Y., 1905, xxii, 
43. 



Wiman. A. — Ueber das vorkommen 
von spirochete pallida bei syph- 
ilis — Nord med. Ark., Stock- 
holm, 1906, 3 f, vi, afd., 2 No. 
3, 1-13. 

Wiman, A. — Ein fall von keratitis 
bei eine jungen kaninchen 
(hereditarsyphilis) — Arch. f. 
Dermat. u. Svph., Wien u. 
Leipz., 1908, xciii, 379-382. 

Winfield, J. M. — Osteopathies of 
quaternary syphilis (Gaucher) 
a report of the examination of 
forty-six orthopaedic cases for 
evidence of inherited syphilis — 
J. Cutan. Dis. incl. Syph., N. 
Y., 1909, xxvi, 394-397! 

Winkler, F. — Der gegemv&rtige 
stand der cytorrhyctesfrage — 
Wien klin. Wehnsclir., 1906, xix, 
340-342. 

Winkler, H. — Ueber nephritis syph- 
ilitica im friihstadium der lues 
—Dermat. Ztschr., Berl., 1909, 
xvi, 281-294. 

Winternitz, R. — Ein beitrag zur 
klinik und anatomie der nodo- 
sen syphilide — Arch. f. Dermat. 
u. Syph., Wien u. Leipz., 1906, 
lxxix, 75-92, 2 pi. 

Winternitz, R. — Ein beitrag zur 
chemisen untersuchung d e s 
blutes rezent luetischer men- 
schen — Arch. f. Dermat. u. 
Syph., Wien u. Leipz., 1908, 
xciii, 65-72. 

Withington, C. F. — A case of dy- 
sarthria probably of syphilitic 
origin — Boston M. and S. J., 
1908, elix, 685. 

Witte, P. — Wirksamkeit der excision 
syphilitischer primaraffekte — 
Arch. f. Dermat. u. Syph., Wien 
u. Leipz., 1907, lxxxv*, 271-276. 

Wolbarst, A. L. — Extra-genital chan- 
cres— N. York M. J., 1905, 
lxxxii, 436. 

Wolf, H. — Die syphilide — Frauen- 
Arzt, Leipz., 1*906, xxi, 242. 

Wolff, L. K. — De serologische diag- 
nose van de syphilis — Nederl. 
Tijdschr. v. Geneesk., Amst., 
1908-. ii, 1761-1776. 

Wolff, M. — Eine entgegnung auf die 
pallida; kritik von Herrn Sal- 
ing — Centralbl. f. Bakteriol., 1 
Abt., Jena, 1906-7, xliii, Orig. 
156. 






Recent Bibliography. 



407 



Wolff, M. — Nochmals zur pallida; 
kritik des Herrn Saling — Cen- 
tralbl. f. Bakteriol., 1 Abt., 
Jena, 1907, xliii, Orig. 803. 

Wolffensperger — Over versehillende 
methoden der serodiagnostiek 
van syphilis — Geneesk. Courant., 
Amst., 1908, lxii, 271-273. 

Wolters, M. — Ueber die bei syphilis 
gefundenen spirochaten— Med. 
Klinik., Berl., 1905, Bd. i, 963. 

Wolters — Ueber die aetiologie der 
syphilis — Kor. Bl. d. allg. Meck- 
lenb. Aerztever., Rostock, 1907, 
274-440. 

Wood, A. C. — An apparently healthy 
child born to parents both of 
whom were in the active stages 
of syphilis at the time concep- 
tion occurred — Am. Med., New 
York and Phila., 1907, ns. ii, 
309. 

Wood, M. A. — Treponema pallidum 
— Texas State J. M., Fort 
Worth, 1908-9, iv, 287. 

Woolley, P. G. — Framboesia; its oc- 
currence in natives of the Phil- 
ippine Islands — Bur. Govt. Lab- 
orat. (Bull.), Manila, 1904, No. 
20, 51-54, 1 pi. 

Woolstein, Martha and Lamar, R. V. 
— The presence of antagonistic 
substances in the blood serum 
in early and late syphilis and 
in paresis and tabes — Arch. Int. 
Med., Chicago, 1908, i, 314-319. 

Wosinsky — Der einfluss der syphilis 
und des alkohols auf die epilep- 
sie — Pest med-chir. Presse, Bud- 
apest, 1907, xliii, 1133, 1162. 

Wotter, O. L. — Is syphilis or mer- 
cury responsible in the etiology 
of dementia paralytica and lo- 
comotor ataxia ? — St. Louis 
Oour. Med., 1906, xii, 65-80. 

Wright, J. H. and Richardson, O. — 
Treponemata ( spirochete ) in 
syphilitic aortitis; five cases, 
one with aneurism — Boston M. 
and S. J., 1909, clx, 539-541, 
lpl. 



Xylander — Die komplementbindungs- 
reaktion bei syphilis impfpocken 
und anderen infektionskrank- 
heiten — Centralbl. f. Bakteriol., 
1 Abt., Jena, 1909, li, Orig. 290- 
304. 



Yamamoto, J. — Eine verbesserung 
der farbungsmethode der spiro- 
chete pallide in geweben — Cen- 
tralbl. f. allg. path. u. path, 
anat., Jena, 1909, xx, 153-155. 

Yearsley, M. — The aural manifesta- 
tions of inherited syphilis — 
Brit. J. Child. Dis., Lond., 1908, 
v, 195-301. 

Yegoroff, K. A. — Galloping malig- 
nant syphilis — Russk. j. kozhn. 
i. ven. boliezn, Kharkov, 1906, 
xi, 97-100. 

Yeltsina, Zinaida Y. — Partial dis- 
trophies following congenital 
syphilis — Russk. j. kozhn. i. ven. 
boliezn, Kharkov, 1905, ix, 129- 
137. 

Yevdokirnoff, V. N. — Non-sexual 
syphilitic infection — Russk. j. 
kozhn. i. ven. boliezn, Kharkov, 
1909, xvii, 278. 



Zabel, A. — Spirochete pallida in aus- 
strichen formalinfixierter or- 
gane — Med. klin., Berl., 1907, 
iii, 580. 

Zabolotony, D. K. — Experimental 
syphilis of the baboons — Arch, 
biol. nauk., St. Petersb., 1904, 
xi, 155-164. 

Zabolotony, D. K. — Experimental 
syphilis upon apes — Russk. j. 
kozhn. i. ven. boliezn, Kharkov, 
1905, x, 62-76. 

Zabolotony, D. u. Maslakowetz — 
Beobachtungen ueber beweglich- 
keit und agglutination der spi- 
rocheta pallida. Vorlaufige 
mitteilung — Centralbl. f. Bak- 
teriol., 1 Abt., Jena, 1907, xliv, 
Orig. 532-534. 

Zabolotony, D. — Zur frage der syph- 
ilispathogenese — Verhandl. d. 
deutsch. dermat. Gessellsch., 
Berl., 1907, 304, 313. 

Zabolotony, D. — Spirochete in syph- 
ilis—Kharkov M. J., 1907, iv, 
312-316. 

Zabolotony, D. K. — Patogenez sifi- 
lisa — Arch. biol. nauk., S. 
Petersb., 1908-9, xiv, 259, 403, 
5 pi. 



408 



Recent Bibliography. 



Zacharias — Demonstration einer von 
einer 26-jiihrigen ii, Para stam- 
menden luetischen plazento mit 
foetus papyraceus — Miinchen 
nied. Woch., liii, 776. 

Zalla, M. — La precipitazione della 
lectina nella sierodiagnosis 
della sifilide e delle affezioni 
metasifllitiche— Riv. di patol, 
nerv., Firenze, 1908, xiii, 385- 
389. 

Zaloziecki, A. — Zur klinischen be- 
wertung der serodiagnostischen 
luesreaktion nach Wassermann 
in der psychiatrie nebst bemer- 
kungen zu den untersuchungs- 
methoden des liquor cerebro- 
spinal — Monatschr. f. Psy- 
chiat. u. Neurol., Berl., 1909, 
xxvi, Ergnzngshft. 196-212. 

Zambilovici — Manoeuvres obstetri- 
cales sur line femme enciente 
atteinte de syphilides genitales 
erosives contagieuses — Bull, et 
mem. Soc. de chir de Buearest, 
1900-7, ix, 242. 

Zappulla, A. — Gomma aifilitica del 
pulmone sinistro — Gazz. sicil. 
di med. et chir., Palermo, 1908, 
vii, 1-4. 

Zaroubine, V. I. — Non-sexual syph- 
ilitic infection — Russk. j. 
kozhn. i. ven. boliezn. Kharkov, 
1907, xiii, 100-181. 

Zaroubine. V. — De l'infection extra- 
genital de la syphilis — -Ann. d. 
mal. ven.. Paris. 1907, ii, 561- 
592. 

Zechmeister, H. — Die syphilid in 
den tropen deren verlauf nnd 
behandlung — Arch. f. SchifTs-u. 
Tropen-Hvg., Leipz., 1908. xii, 
350-359. 

Zeidlitz, P. — Ueber die verwend- 
barkeit der almenschen wis- 
muthprobe fiir die untersuch- 
ung syphilitischer zuckerarne — 
Upsala Lakaref Forh Festkr., 
Hammarsten, 1906, pt. 22, 1-17. 

Von Zeissl, M. — Die luetischen er- 
krankungen des urogenital ap- 
parates und ihre behandlung — 
Wien med. Presse, 1906, xlvii, 
69-74. 

Von Zeissl, M. — Einige bemerkun- 
gen ueber die behandlung der 
syphilis — Miinchen med. Woch., 
1905, Bd. lii, s. 1881. 

Von Zeissl, M. — Zwei weitere fSIle 
von gummen am penis — Wien 
med. Presse, 1907, xlviii, 502. 



Von Zeissl, M. — Die erkrankungen 
des urogenitalapparates bei 
mann u. weib infolge von syph- 
ilis — Deutsche Klin., Berl., 
1906, x, 645-656. 

Von Zeissl, M. — Zwei interessante 
luesfalle ( muskel-hoden und 
bindehautsyphilis) und aus die- 
sen beobachtungen gezogene 
sehlusse — Miinehen med. Woch., 
1909, lvi, 1891-1893. 

Zeit, F. R. — The spiroclueta pallida 
as etiological factor of syphilis 
- — Quart. Bull. Northwestern 
Univ. Med. School, Chicago, 
1908-9, 17-42. 

Zeleneff, I. F. — The spirochsta of 
syphilis — Russk. j. kozhn. i. 
ven. boliezn. Kharkov, 1905, ix, 
305. 

Zeleneff, I. F. — ( Spirochseta of syph- 
ilis) — Russk. j. kozhn. i. ven 
boliezn, Kharkov, 1905, X, 187- 
201, 1 pi. 

Zeleneff. I. F. — Spirochsta-like 
forms as a product of degener- 
ation of polychromopolymor- 
phus mucor — Russk. j. kozhn. 
i. ven. boliezn, Kharkov, 1906, 
xli. 285. 

Zeleneff, I. F. — Black syphilis chan- 
cre — Russk. j. kozhn. i. ven. 
boliezn, Kharkov. 1907, xiii, 
308-312, 12 pi. 

Zeleneff, I. F. — Negative side of 
Wassermann's reaction — Russk. 
j. kozhn. i. ven. boliezn, Khar- 
kov, 1908, xvi, 247-255. 

Zeleneff, I. F. — Infusoria in syph- 
ilitic ulcers — Russk. j. kozhn. i. 
ven., Kharkov, 1908, xv, 288, 
2 pi. 

Zemlhoff, V. I. — Distribution of 
syphilis along the railroads and 
measures to prevent it — Russk. 
j. kozhn. i. ven. boliezn, Khar- 
kov, 1908, xv, 243-262. 

Zerenin, P. — Sluchai syphilis ma- 
lignse ■ — Med. obozr., Mosk., 
1905, lxiv, 488-492. 

Zettnow — Farbung und theilung bei 
spirochseten — Ztschr. f. Hyg. u. 
Infectionskrankh, Leipz., 1906, 
lii, 485-494, 1 pi. 

Zhuvovski, V. P. — Fatal hemorrhage 
from the liver in hereditary 
syphilis in childhood — Med. 
Obozr., Mosk., 1905, lxiii, 106- 
110. 



Recent Bibliography. 



409 



Zhuvovski, V. P. — New sign of con- 
genital syphilis — J. akush. i. 
jensk. boliez, St. Petersb., 1905, 
xix, 276. 

Zhuvovski, V. P. — A new sign of 
congenital syphilis — Med. 
Obozr., Mosk., 1905, lxiii, 473- 
479. 

Ziegel, H. F. L. — Precocious ter- 
tiary syphilis; report of a case 



with manifold manifestations — 
Med. Rec, N. Y., 1909, lxxvl, 
645. 

Ziehen, T. — Syphilitische erkrank- 
ungen im bereich der hinteren 
schadelgrube — Therap. d. Ge- 
genw., Berl., 1906, xlvii, 16-49. 

Zieler — Zwei falle sogenannter ma- 
ligner syphilis — Allg. med. 
Centr. ztg., Berl., 1907, lxxvi, 
467. 



INDEX 



Abortions, 34. 
Abscess of tongue, 76. 
Accessory sinuses, 145. 
Acne, 63. 

cachecticorum, 63. 

frontalis, 63. 

necrotica, 63. 

rosacea tuberosa, 62. 

varioliformis, 63. 

vulgaris, 63. 
Acquired syphilis, 38. 
Acromegaly, 284. 
Actinomycosis, 135. 
Actinomycosis, 245, 246. 
Acute articular rheumatism, 250. 
Acute bulbar paralysis, 250. 
Acute exanthemata, 54. 
Acute polymyositis, 252. 
Acute yellow atrophy, 105. 
Addiment, 9. 
Adenopathy, 42. 
Age, 67. 
Agglutinins, 9. 
Albuginitis, 215. 
Albuminuria, 197. 
Alexia, 257. 
Alexin, 9. 
Alopecia, 51. 
Amblyopia, 285. 
Amboceptor, 9, 10. 
Amyloid degeneration, 52, 107, 180. 
Anemia, 48, 179. 

syphilitic, 179. 
Aneurysm, 179, 259. 
Angina, 83. 

Angina, simple, 66, 69. 
Angina syphilitica erythematosa, 

69, 83. 
Angioneurotic eruptions, 56. 
Annular induration, 39. 
Antibody, 10. 
Antiferment, 9. 
Antigen, 10. 
Antitoxins, 9. 
Anus, 116. 
Aortic valve, 248. 
Aphasia, 257. 
Aphtha, 66, 69. 
Arms, 52. 

Arsenical keratosis, 61. 
Arteriosclerosis, 179. 
Arteritis, 179. 
Arthralgia, 247. 
Arthritis, 250. 



Arthropathies, 247. 

Ascites, 106. 

Aspermia, 225. 

Asphyxia, 263. 

Ataxia, 255, 265. 

Atheroma, 178. 

Atrophic rhinitis, 128, 138. 

Atrophy, muscular, 251. 

Atrophy, optic nerve, 255. 

Atrophy, syphilitic, of gland follicles 
at base of tongue, 72. 

Auditory center, syphilitic affec- 
tion, 257. 

Auditory nerve, 257. 

Azoosperma, 225. 



Bacillus, lustgarten, 2. 

smegma, 2. 

tubercle, 2. 
Bacteriology, 1. 
Bacteriolysins, 9. 
Basilar meningitis, 260, 271. 
Beri-beri, 284. 
Bibliography of spirochete pallida 

and serum reaction, 17. 
Bladder, syphilis of, 198. 
Blepharitis, 275. 
Blood, 8, 179. 
Blood vessels, 179. 
Bone, 237. 
Bones of nose, 126, 239. 

facial, 240. 

forearm, 241. 

frontal, 239. 

hard palate, 70, 239. 

hyoid, 239. 

leg, 241. 

long, 241. 

occipital, 238, 239. 

orbital, 240. 

parietal, 238, 239. 

small, 241. 

temporal, 239. 

upper jaw, 240. 
Brachial neuralgia, 266. 
Brain, 254. 
Brain, irritation, 254. 

syphilis, 254. 
Breast, 195. 

chancre, 195. 

chancroid, 196. 

gumma, 196. 

mucous patch, 196. 

syphilides, 196. 

411 






412 



Index. 



Brieger serum test, 14. 

Bright's disease, 178, 197. 

Bronchi, 170. 

Bruck, 14. 

Buboes, 184. 

Bubo, indolent, 42, 184. 

cancerous, 188. 

glanders, 190. 

inflammatory, 185. 

leprosv, 189. 

syphilitic, 42, 184. 

syphilitic vs. inflammatory, 191. 

tuberculous, 186. 

venereal, 42, 185. 
Bulls, 35. 
Bursa, 253. 
Bursitis. 253. 



Cachexia. 180. 

mercurial, 180. 

strumapriva, 180. 

svphilitic, 180, 338. 
Callus. 61. 
Cancer, cutaneous, 62. 

larynx. 161, 104. 

lingual, 81. 

liver. 107. 

mouth. 67, 

nose. 128, 136, 142. 

rectum, 118. 

stomach, 87. 

testicle, 221. 
Carcinoma, 46, 81, 128. 
Carotid artery, 255. 
Cartilaginous induration, 39. 
Catarrh, 69, 83, 125, 146, 153. 
Catarrh of stomach. 86. 
Caudate nucleus, 255. 
Central ganglia, 259. 
Cerebellum. 258. 
Cerebrum, 259. 
Cerebral aneurysm, 259. 

ganglia, 259. 

hemorrhage, 259. 

nerves. 257. 

peduncles, 258. 

softening, 259. 

symptoms, 259. 

syphilis, 254. 

vessels. 259. 

compression, 239. 
Cerebrospinal fluid, 12, 264. 
Cerebrospinal syphilis, 273. 
Cervical spine, 240. 

spondvlitis, 240. 
Chalazion,' 274. 
Chancre v. abrasions, 46. 

carcinoma, 46. 



chancroid, 44. 

gumma, 46. 

herpes, 46. 
Chancre, 38, 40. 

herpetiform, 47. 

Hunterian, 38. 

indurated, 38. 

in hairy regions, 43. 

oral, 65. 

oral. 76. 

soft, 44. 

tonsils, 82. 

ulcerated, 40. 

urethral, 199. 
Chancroid, 44. 
Chiasm, 255. 
Chloasma. 57. 
Chlorosis. 179. 

svphilitic. 179. 
Choked disk, 282. 
Chorioretinitis, 280. 
Choroid, 279. 
Choroiditis centralis, 279. 

diffuse exudative, 279. 
Chronic rheumatism, 250. 
Ciliary body, 279. 
Circulatory system, 174. 
Cirrhosis of the liver, 107. 
Cirrhosis of liver, 113. 
Clavicle, 241. 
Cochlea, 288. 
Colds, 153. 
Colitis. 101. 
Colles' law, 31. 
Complement, 9. 

deviation, 10. 

binding, 10. 
Conclusion, 291. 
Condyloma. 57. 

acuminata, 57. 

lata. 59. 
Congenital immunity, 32. 

syphilis, 32. 
Conjunctiva, 275. 

chancre, 275. 

copper colored spots, 275. 

gummata. 275. 

mucous patches, 275. 

nodular syphilides, 275. 

papular syphilides, 275. 

syphilitic ulcer, 275. 
Conjunctivitis, 275. 
Constitutional symptoms, 47. 
Convulsions, 36. 
Copaiba eruption, 55. 
Copper colored eruptions, 50. 
Copula. 10. 
Cord, spinal, 261. 
Cornea, 277. 
Coronary arteries, 267. 






Index. 



413 



Corpora quadrigemina, 258. 

Coryza, 36, 126. 

Cottes' law, 31. 

Crossed paralysis, 258. 

Cubebs eruption, 55. 

Cutaneous and mucous lesions, 48. 

Cutis marmorata livida, 56. 

Cyelitis, 278, 279. 

Cylindruria, 197. 

Cytase, 9. 

Cytolysins, 9. 

Cytotoxins, special, 9. 



Dacryoadenitis, 275. 
Dacryocystitis, 275. 
Dactylitis, 241. 

syphilitica, 242. 

tubercular, 242. 
Dark ground illumination, 3. 
Dead bone, 35. 
Deafness, syphilitic, 288. 
Deep sclerosing glossitis, 72. 
Defluvium capillorum, 51. 
Deformity, 126. 
Degeneration, amyloid, 180. 
Dementia paralytica, 255. 
Dental glossitis, 79. 
Desmon, 10. 
Diabetes, 142, 271. 
Diaphragmatic pleurisy, 107. 
Diaphysis, 241. 
Diarrhoea, 102. 
Diphtheria 66, 69, 144, 284. 
Disse and Taguchi, 1. 
Donn6, 1. 

Drug eruptions, 55. 
Drum membrance, 288. 
Drumstick fingers, 242. 
Dry papules, 57. 
Duodenal ulcer, 104. 
Dura mater, 255. 
Dysentery, 104. 
Dysphagia, 85. 
Dyspnoea, 178. 



Ear, 52, 287. 

Early eruptions, 50. 

Eczema, 61, 141. 

Edema of the larynx, 157. 

Elbow, 247. 

Enanthem, 36, 51, 66, '68, 149. 

Encephaloid carcinoma of testisle, 

222. 
Enchondroma, 242. 



Endarteritis, 179, 254. 

obliterans, 179. 
Endocarditis, 174, 178. 
Enteritis, 101. 
Ependymitis, 254. 

syphilitica, 257. 
Epididymitis, 52, 218. 
Epigastric juice, 116. 
Epiglottis, 149. 

Epiglottitis, simple acute, 156. 
Epilepsy, 260. 

syphilitica, 257. 
Epiphysis, 246. 
Epiphysis, 241, 243, 246, 249. 
Bpistaxis, 141. 
Epithelioma, 62, 75, 77. 
Erysipelas, 178, 238. 
Erythema, 54, 149. 

annulare, 56. 

iris, 56. 

nodosum, 59. 

non-syphilitic, 56. 

syphilitic, 54, 59. 
Esophagus, 84. 

carcinoma, 85. 

neurotic dysphagia, 85. 

stricture, 85. 
Ethmoid bone, 127. 
Ethmoiditis, 145. 
Evolution of syphilis, 50. 
Exanthem, 48,' 53. 
Extra-genital infection, 41. 
Eye, 51, 240, 274. 
Eyebrow, 274. 
Eyelashes, 274. 
Eyelids, 274. 

chancre, 274. 

chalazion, 274. 

gummata, 274. 

hordeola, 274. 

infiltration, 274. 

initial scleroses, 274. 

papules, 274. 

pustules, 274. 

macules, 274. 

syphilides, 274. 

syphilitic ulceration, 274. 



Face, 52. 

Facial paralysis, 267. 
Falling of hair, 51. 
Fallopian tubes, 233. 

gummata, 233. 

syphilides, 233. 
Falx cerebri, 255. 



414 



Index. 



Fasciae, 253. 

gummata. 253. 

infiltrations, 253. 
Fatty diarrhcea, 116. 
Fauces, chancre, 43. 
Fecal impaction, 124. 
Female generative organs, 226. 
Fetus, 35. 
Fetus in utero, 35. 
Fever, 47. 

Fibrous tumors, 214. 
Fingers, 241. 
First stage, 38. 
Fistulae, 120. 
Fixateur, 10. 
Flagella, 8. 
Fleming test, 14. 
Fontanelles, 246. 
Foot. 242. 

Fragilitas ossium, 238. 
Framba?sia, 64. 
French measles, 55. 
Forearm, ciiancre, 44. 
Frontal bone, 239. 
Fungus testiculi malignus, 217. 

syphiliticus. 215. 
Furunculosis, 178. 



Gallstones, 107. 
Gastric catarrh, 87. 

neuroses, 87. 
Gastritis, 86. 

Generalized sclerosing glossitis, 72. 
Generative organs, 205, 226. 
German measles, 55. 
Ghoreyer stain, 7. 
Giant papules. 57. 
Giemsa stain. 4. 
Girdle pains. 262. 
Glanders. 128, 135, 143. 
Glands. 182. 
Glossitis. 71, 78. 

cicatrisans, 71. 

decubital. 79. 

dental, 79. 
Glycosuria, 116. 
Goldhorn stain. 5. 
Gonorrhoea, 178. 216, 284. 
Gonorrheal epididvmitis and orchi- 
tis. 219. 
Gonorrheal rheumatism, 250. 
Gout, 242. 
Grunwald stain, 6. 
Gumma, 52. 

cancerous affection of, 85. 

cutaneous, 197. 

bone, 70, 237. 

brain, 255. 



breast, 196. 

bursa?, 253. 

cerebral meninges, 255. 

conjunctiva, 276. 

crus, 271. 

dura mater, 255. 

ear, 288. 

esophagus, 85. 

eyelids. 274. 

fallopian tubes, 233. 

gums. 70, 

hard palate, 70. 

heart, 174. 

iris, 278. 

joints, 247. 

kidneys, 197. 

larynx, 151, 161. 

liver, 105. 

lymphatic glands, 183. 

lymphatic vessels, 183. 

medulla oblongata, 258, 271. 

mouth, 66. 70, 76. 

muscles, 251. 

nose, 126. 

of alveolar process, 70. 

ovaries, 233. 

palate, 70. 

penis, 207, 213. 

periosteum, 236. 

pia mater, 255. 

pons, 271. 

rectum. 117. 

sclera. 276. 

skin, 52. 

soft palate, 70. 

stomach, 86. 

subcutaneous connective tissue, 

52. 
submucous, 52. 
testicle. 215. 218. 
tongue, 70, 73, 75. 
tonsils, 70, 83. 
urethra, 199. 
uterus, 232. 
uvula, 70. 
vagina. 232. 
Gums, chancre of, 70. 



Haemolysins, 9. 
Haemolvsis, 9. 
Hair, 38, 51. 
Hard palate. 70. 
Hay fever, 132. 
Headache, 254, 256. 
syphilitic, 255. 
Heart, 174. 
Hecht, 11. 



Index. 



415 



Hemianopsia, 259. 
Hemiparesis, 259. 
Hemiplegia, 257. 

alternans inferior, 258. 
Hemolysins, 9. 
Hemorrhage, gastric, 87. 

cerebral, 179, 259. 
Hemorrhage, cerebral, 179, 259. 

gastric, 87. 
Hemorrhoids, 121. 
Hepatic congestion, 107. 
Hepatitis, 104. 
Hepatoxin, 9. 
Hereditary syphilis, 32. 
Herpes, progenitalis, 46. 
Heterophoria, 286. 
Hoffmann, 1. 
Hordeola, 274. 
Hutchinson teeth, 82. 
Hyalitis syphilitica, 281. 
Hydrarthrosis, 249. 
Hydrocephalus internus, 254. 

syphiliticus, 257. 
Hygromata, 253. 
Hyoid, syphilitic necrosis, 239. 
Hysteria, 260. 



Ichthyosis, 78. 

linguae, 78. 
Icterus, 104. 

neonatorum, 36, 111. 

syphilitic, 104. 

syphilitoxic, 105. 
Idiocy, 35. 
Immune body, 9, 10. 
Impotence, 225. 
Incubation, 38, 47. 

long, 47. 
Indirect syphilis of stomach, 877. 
Indolent buboes, 42. 
Indurated chancre, 39. 
Indurated edema, 42. 
Infection, methods of, 31. 
Influenza, 284. 
Initial lesion, 38. 
Intercostal neuralgia, 266. 
Intermediary body, 10. 
Internal capsule, 259. 

ear, 288. 
Intestinal syphilis, 101. 

cancer, 103. 

carcinoma, 103. 

catarrh, due to anti-syphilitics, 
102. 

catarrh, simple, 102. 

neoplasms, 103. 

sarcoma, 103. 

tuberculosis, 102. 

ulcer, 102. 



Intestine, 101. 
Intracranial tumor, 281. 
Invasion, 47. 
Iridochoroiditis, 279. 
Iridocyclitis, 279. 
Iris, 277. 
Iritis, 52, 277. 

gummatous, 277. 

non-syphilitic, 277. 

papulosa, 277. 

simple, 279. 

syphilitic, 279. 
Irritability, mental, 256. 



Jaundice, 109. 

Jaw bone, upper, 240, 241, 245, 246. 

Joints, 247. 

rheumatism, 250. 

syphilis, 249. 

trauma, 250. 

tuberculosis, 250. 



Keratitis, 52, 277. 

inherited, 52. 

interstitial, 277. 

parenchymatous, 277. 

syphilitic, 277. 
Keratosis, 78. 

linguae, 71. 
Kidney, amyloid, 197. 

amyloid, 197. 

granular, 197. 

gummatous infiltration, 197. 
Klausner test, 13. 
Knee, 247. 
Kyphosis, 240. 



Labyrinth, 288. 
Laminated induration, 39. 
Laryngeal ulcers, 150, 161. 

carcinoma, 161. 

chondritis, 160. 

edema, 157. 

erythema. 149. 

growths, 163. 

gumma, 151, 161. 

hemorrhage, 158. 

pemphigus, 150. 

sarcoma, 162. 

tuberculosis, 160. 
Laryngitis syphilitica erythematosa, 
149. 



416 



Index. 



Laryngitis, 153. 

acute, 154. 

atrophic, 159. 

chronic. 159. 

follicular, 159. 

granular, 159. 

hemorrhagic, 158. 

hyperplastic, 159. 

infections, 154. 

raembrauous, 158. 

rheumatic. 156. 

suppurative, 157. 

traumatic, 157. 
Larynx, 149. 

adenoma, 165. 

angioma, 166. 

carcinoma, 161, 164. 

chondritis and perichondritis, 
160. 

chondroma, 166. 

edema of, 157. 

fibroma, 165. 

lipoma, 166. 

lupus, 167. 

mucocele, 

myxomata, 166. 

papilloma, 165. 

pemphigus, 160. 

sarcoma, 162, 164. 

scleroma, 152. 

simple hyperemia, 159. 

stenosis, 168. 

tuberculosis, 166. 
Lecithin, 10. 
Legs, 52. 

Lenticular nucleus, 255. 
Lenticular papules, 57. 
Leprosy. 125, 135, 143. 

tubercular, 62. 
Leucomata, 78. 
Leucocytosis. 48. 179. 
Leucoderma. 57. 
Leucoplakia buccalis, 78. 

lingua;, 78. 
Leucoplasia buccalis, 78. 
Leukaemia. 48. 
Lichen ruber planus, 58, 61. 

pilaris, 58. 

scrofulosum, 58. 
syphiliticus, 57, 59. 
Lingua geographiea, 66, 69. 
Lipoids, 10. 
Lips, chancre of, 67. 

epithelioma, 67. 

gumma, of. 67. 

ulcer of, 65. 
Lips, mucous patches, 68. 
Livaditi stain, 7. 



Liver, abscess of, — 

acute yellow atrophy, 105. 

cancer, 104. 

cirrhosis, 113. 

syphilis, 104. 
Locomotor ataxia, 35, 255, 265. 
Loeffler stain, 8. 
Long bones, 241. 
Long incubation, 47. 
Lungs, 171. 
Lupus, 62. 

nose, 127, 134. 

vulgaris, 62, 63. 
Lustgarten. 1. 

bacillus, 2. 
Lymphadenitis, 182. 
Lymphadenopathy, cancerous, 188. 

glanders, 190. 

inflammatory, 185. 

leprous, 189. 

syphilitic, 184. 

tuberculous, 186. 
Lymphangitis, 19. 

indurated, 43. 

inflammatory, 191. 

syphilitic, 48, 191. 
Lymphatic anemia, 48, 179. 

glands, 182. 

vessels, 43. 

M 

Macroglossia, 74. 

Manila, pediculi pubis, 56. 

syphilitica, 54. 
Macular syphilide, 54. 
Madarosis, svphilitic, 274. 
Malaria, 278, 284. 
Male generative organs. 205. 
Mammae, 195. 
Mammary chancre, 43. 
Mania, 2*60. 
Marino stain, 4. 
Mastitis syphilitica, 195. 
Mayer and Proescher test, 13. 
Measles. 55. 
Meat poisoning. 252. 
Medulla oblongata, 258. 
Meiostagmin reaction, 16. 
Meningeal irritation, cerebral, 254. 

spinal, 261. 
Meninges. 254. 
Meningitis, 254. 

cerebral, 254. 

gummosa, 271. 

gummosa basilaris diffusa, 255. 

spinal, 261. 
Meningomvelitis syphilitica, 264. 
Mental failure. 35. 
Mental irritability, 259. 



Index. 



417 



Mental obscurity, 272. 
Mercury eruption, 55. 
Middle ear, 288. 
Miliary eruption, 57. 
Mitral valve, 248. 
Moist papules, 57. 
Molluscum contagiosum, 61. 
Monoplegia, 257. 
Morphcea, 135. 
Mother of pearl ostitis, 242. 
Mouth, 65. 

erosions, 66. 

gumma, 66. 

mercurial ulcers, 69. 

syphilis, 65. 
Mucous membranes, 53. 

patches, 51, 66, 68. 

patches, oral, 66, 68. , 
Multiple sclerosis, 264. 

syphilitic root neuritis, 265. 
Muscles, 251. 

actinomycosis, 252. 

atrophy, 251. 

cicatricial contraction, 251. 

gumma, 251. 

interstitial infiltration, 151. 

myositis, 251. 

rheumatic pains, 251. 

sarcoma, 252. 

sinous ulcer, 251. 

syphilitic myositis ossificans, 
251. 

trichinosis, 252. 
Muscular rheumatism, 250. 
Myalgia, 250. 
Myelitis syphilitica, 264. 
Myocarditis, 174, 176. 

acute diffuse, 176. 

interstitial, 176. 

parenchymatous, 176. 
Myositis ossificans, 251. 
Myxedema, 284. 



N 

Nails, 51. 

Nasal ducts, 276. 

Nasal hydrorrhcea, 139. 

ulcer, 140. 
Nasopharyngitis, 148. 

atrophic, 148. 

hyperplastic, 148. 

simple, 148. 
Nasopharynx, 146. 

actinomycosis, 148. 

cancer, 148. 

gangrenous ulceration, 148. 

glanders, 148. 

tuberculosis, 148. 

tumors, 148. 



Nausea, 254. 

Neck, 52, 246. 

Necrosis, disseminata, 243. 

mercurial, 242. 

phosphorous, 242. 

syphilitic, 238. 
Nephritis, 197. 

acute, 197. 

chronic, 197. 

subacute, 197. 
Nephrotoxin, 9. 
Nerve, auditory, 257. 

abducens, 257. 

facial, 257. 

hypoglossals, 257. 

oculomotor, 267. 

olfactory, 257. 

optic, 257. 

peripheral, 265. 

trochlear, 257. 

trigeminal, 257. 

vagus, 258. 
Nerves, 265. 
Nervous system, 254. 
Neuralgia, syphilitic, 266. 

brachial plexus, 266. 

intercostal, 266. 

nervus auricularis magnus, 266. 

occipitalis major, 266. 

peripheral, 266. 

sciatica, 266. 

trigeminal, 266. 

visceral, 266. 
Neuritis, 265. 

optic, 281. 
Niessen, 1. 

Nodular induration, 39. 
Noguchi serum test, 13. 
Nose, 125. 

O 

Ocular muscles, 286. 
Oligospermia, 225. 
Onychia syphilitica, 51. 
Oophoritis, syphilitic, 233. 

epithelioma, 77. 

gumma, 76. 

syphilis, 65. 

tuberculosis, 78. 
Ophthalmitis, 277. 
Ophthalmoplegia, 255. 
Optic nerve, 52, 281. 

neuritis intrabulbar, 282. 

retrobulbar, 282. 
Oral chancre, 65, 76. 

cancer, 66. 

chancroid, 66. 

diphtheria, 66. 

gumma, 66. 

mucous patches, 66. 

tuberculosis, 66. 



418 



Index. 



Orbit, 240, 274. 
Orchitis, 215. 

cancerous, 221, 222. 

epidemic (mumps), 224. 

gonorrheal, 219. 

gummosa, 215. 

syphilitic, 218. 

traumatic, 224. 

tubercular, 220. 
Organs, the various, 53. 

hearing, 287. 

locomotion, 234. 

sight, 274. 

smell, 274. 

special sense, 274. 

taste, 290. 
Ornithodorus moubata, 34. 
Oscillating hemianopsia bitem- 

poralis, 258. 
Osmic acid stain, 7. 
Osteochondritis, epiphyseal, 35, 249. 
Osteomlacia, 245. 
Osteomyelitis, 238. 
Osteoporosis, 238. 
Osteopsa thyrosis, 238. 
Ostitis, 23S. 

gummatous, 238. 

sclerosing, 338. 

simple, 238. 

syphilitic, 238. 

tuberculous, 244, 245. 
Otitis, 287. 

media syphilitica, 288. 
Oedema indurativum, 42. 
Oedema sclereux, 42. 
Ophthalmoplegia interna, 287. 
Ovaries, 233. 
Ozena, 127, 138. 

syphilitica, 127, 138. 



Pachymeningitis, 254. 

hemorrhagica, 254. 

syphilitica. 254. 
Pain, in syphilis, 247. 
Palate, 70! 
Palmar eczema, 61. 

eruption, 59. 
Palpitation, 174. 
Pancreas, 115. 
Pancreatitis, 115. 
Papillitis, k.o2. 
Papilloma, 57. 

venereal, 61. 
Papulae humidae, 57. 
Papular syphilide, 57. 
Papule syphilitic, 57. 
Papule, ulcerated. 60. 
Paralysis, 263, 265. 



abducens, 267. 

auditory, 267. 

facial, 267. 

hypoglossal, 267. 

oculomotor, 267. 

spinal, 264. 

syphilitic. 267. 

trigeminal, 267. 
Paralytic dementia, 35. 
Paraplegia, 263. 
Parasyphilitic affections, 15. 
Parchment induration, 39. 
Paresis, 260. 
Parietal bones, 239. 
Paronychia. 51, 242. 
Parotitis, 52. 

Pediculi pubis, maculse, 56. 
Peduncles, 258. 
Peevishness, 36. 
Pelagra, 284. 
Pemphigus, 35, 36. 
Penis, 205. 

cancer, 210. 

chancre, 205, 207, 208. 

chancroid. 209. 

epithelioma, 210. 

gumma, 213. 

papular syphilides, 213. 

pustular ulcer, 212. 

roseola. 205. 

simple tumors, 214. 

tubercle, 211. 
Pericarditis, 177. 
Perihepatitis, 106. 
Perineuritis, syphilitic, 266. 
Periorchitis syphilitica, 215. 
Periosteum, 234. 
Periostitis, 234. 

gummatous, 236. 

ossifying, 234. 

suppurative, 235. 

syphilitic, 234. 

ulcerative, 236. 
Peripheral nerves, 265. 
Peritoneum, 116. 
Peritonitis, 35. 116. 
Pernicious anemia, 179. 
Phalangitis syphilitica, 242. 
Pharynx, 69. 
Phlebitis, 179. 
Phosphorous necrosis, 242. 
Phthisis syphiliticus, 171. 
Pia mater, 255. 
Pigment liver, 107. 
Pigmentary syphilide, 56. 
Pineal body, syphilis of, 
Plaques opalines, 68. 

syphilitic, 68, 71. 
Pleura, 174. 
Pleurisy, 171. 



Index. 



419 



Pneumonia, syphilitic, 171. 

Polymyositis, 252. 

Polypi of rectum, 122. 

Pons varolii, syphilis of, 258. 

Porges-Meier serum test, 13. 

Prfeperateur, 10. 

Precipitins, 9. 

Primary sore, 38, 40, 41. 

Proca stain, 5. 

Proctitis, 125. 

Proctitis, 116. 

Profeta's law, 32. 

Prolapse of the rectum, 122. 

Pruritus, 122. 

Pseudo-chorea, 257. 

Pseudo tabes syphilitica, 264. 

Pseudo-trichinosis, 252. 

Psoriasis, 59. 

lingua, 78. 

palmaris, 59, 61. 

plantaris, 59. 

punctate, 58. 

vulgaris, 60. 
Pulmonary syphilis, 171. 

tuberculosis, 172. 
Pulse, slow in meningeal irritation, 

256. 
Punaise, 127. 
Punctate psoriasis, 58. 
Pupils, immobility, 255. 
Pustula tada, 60. 
Pustular syphilide, 63. 
Pylephlebitis, 107. 



Quinsy, 178. 



Ray fungus, 245. 
Rectal syphilis, 116. 

abscess, 120. 

cancer, 116. 

prolapse, 122. 

stricture, 123. 

tuberculosis, 116. 

ulcer, 123. 
Rectum, 116. 

chancre, 117. 

gumma, 117. 

syphilide, 117. 
Renal syphilis, 197. 
Respiratory tract, 125. 
Retina, 280. 

hyperemia, 280. 

irritation, 280. 

syphilitic, 280. 



Retinitis, 280. 

catarrhalis syphilitica, 280. 

gummosa, 280. 

proliferans, 281. 

syphilitica atrophica, 280. 
Retrobulbar optic neuritis, acute, 
285. 

chronic, 285. 

fulminant, 285. 

syphilitic, 284. 

toxic, 285. 
Rheumatism, 250. 
Rheumatoid arthritis, 242. 
Rhinitis, 129. 

acute, 129. 

acute edematous, 132. 

acute infections, 131. 

atrophic, 138. 

chronic, 133. 

chronic edematous, 139. 

chronic intumescent, 137. 

hyperplastic, 137. 

membranous, 131. 

occupation, 132. 

phlegmonous, 132. 

purulent, 139. 

toxic, 130. 

tubercular, 134. 

ulcerative, 132. 
Rhinoscleroma, 127, 136. 
Ribs, 241. 
Rickets, 243. 
Rodent ulcer, 117. 
Romanowsky stain, 4. 
Roseola, 54. 

balsamica, 55. 

syphilitica, 54. 
Rotheln, 55. 
Rubella, 55. 



Sacro-coccygeal arthralgia, 125. 
Saddle nose, 126. 
Salivary glands, 
Salpingitis, 233. 
Santal oil eruption, 55. 
Saprophitic spirochetes, 3. 
Sarcoma, 244, 252. 
Sarcomatosis of brain and cord, 273. 
Scabies, 58. 
Scalp, 52. 
Scarlatina, 284. 
Scarlet fever, 55. 
Scars, smallpox, 56. 
Schaudinn, 1. 
Sciatica, 266. 
Sclera, gummata, 277. 
Sclerosing glossitis, 71. 
second stage, 477. 



420 



Index. 



Sclerosis, syphilitic, 71. 

Sclerotic, 277. 

Scotoma, 282. 

Secondary lesions, 477. 

Semen, 225. 

Senile appearance, 36. 

Sequestrum, 240, 241. 

Serodiagnosis, 9. 

Serology, 9. 

Serum diagnosis, 9. 

Sinus, ethmoidal, 145. 

sphenoidal, 145. 
Shoulders, 52. 
Skin, 53. 

Spasmodic tabes dorsalis, 265. 
Special sense, organs of, 274. 
Speech, 71. 
Spermatoxin, 9. 
Sphenoid sinus, 145. 
Sphenoidal sinus, empyema, 145. 
Spinal column. 240. 

cord. 261. 

meningitis, 262. 

syphilis, 261. 

tracts. 262. 
Spinal paralysis. 264. 
Spine, 244. 

Spirillum Obermeiri, 3. 
Spirochetes in blood. 8. 
Spirochete pallida, 1, 2. 

in congenital syphilis, 33. 

pertensis, 64. 

refrigerans, 1. 
Spirochetes in carcinoma, 68. 
Spleen. 192. 
Spondylitis. 240. 
Skul!.' 239. 

Small acuminate papules, 58. 
Small bones. 241. 
Smallpox, 63, 155. 

scars, 56. 
Smell, 289. 
Smoker's patches, 78. 

tongue, 72, 78. 
Snuffles, syphilitic, 36. 
Soft palate, 70. 
Soles of feet, 242. 
Softening of the brain, 254. 
Stenosis of esophagus, 85. 
Stomach. 85. 
Stomatitis, catarrhal, 69. 

iodic, 70. 

mercurial, 69. 

syphilitic, 36, 68. 
Stricture, esophageal, syphilitic, 85. 

laryngeal, sphilitic, 152, 168. 

nasal duct, 275. 

rectal, 123. 

tracheal, syphilitic, 169. 

urethral, syphilitic, 206. 



Subcutaneous gumma, 52. 
Substance sensibilisatrice, 10. 
Substitutes for the Wassermann 

reaction, 12. 
Superficial sclerosing glossitis, 72. 
Suprarenal glands, 195. 
Surgical sepsis, 178. 
Synovitis, 243. 
Syphilides. 48, 53. 

broad, 59. 

characteristics of, 48. 

diagnosis of from leprosy, 62. 

large, 61. 

lenticular papule, 57. 

location, 48. 

macular, 54. 

maculopapular, 54. 

miliary papular, 57. 

moist, 59. 

palmar papular, 59. 

papular. 53. 

papulosquamous, 59. 

pigmentary, 56. 

plantar papular, 59. " 

pustular, 63. 

squamous, 60. 

tubercular, 61. 

ulcerated, 51. 

vesicular, 54. 
Syphilis, acquired, 38. 

breast, 195. 

cutanea maculosa. 54. 

heart, 174. 

hepatic, 104. 

hereditary, 32. 

laryngeal, 149. 

nasal, 125. 

penis, 205. 

periosteum, 234. 

pons, 258. 

pulmonary, 171. 

renal, 197. 

tarda, 38. 

tongue, 65. 71, 79. 

vulva, 226. 
Syphilitic catarrh, 149. 

affections of skin and mucous 
membrane, 53. 

affections of the circulatory or- 
gans, 174. 

affections of the digestive or- 
gans, 65. 

affections of the female gener- 
ative organs, 226. 

affections of the glands, 182. 

affections of the male genera- 
tive organs, 205. 

affections of the nervous sys- 
tem, 254. 



Index. 



421 



affections of the organs of hear- 
ing, 287. 

affections of the organs of lo- 
comotion, 234. 

affections of the organs of spe- 
cial sense, 274. 

affections of respiratory organs, 
125. 

affections of the urinary or- 
gans, 197. 

anemia, 48, 179. 

chlorosis, 48, 179. 

erythema, 54. 

hepatitis, 104. 

laryngitis, 149. 

leukaemia, 48. 

plaques, 71. 

roseola, 54. 

snuffles, 146. 
Syphilotoxines, 109. 



Tabes dorsalis, 35, 265. 
Tarsitis syphilitica, 274. 
Taste, disturbances of, 290. 
Teeth, 82. 
Tear ducts, 276. 
Temperature, 47. 
Tendon sheaths, 252. 
Tendons, 252. 
Testicles, 215. 
Thigh, chancre, 44. 

gumma, 52. 
Third stage, 52. 
Thrush, — . 
Thymus gland, 192. 
Thyroid gland, 193. 
Tick, 34. 

fever, 34. 
Tinea circinata, 56, 60. 

versicolor, 56, 57. 
Tissue sections, 7. 
Toes, 242. 
Tongue, 65. 

chancre, 65. 

epithelioma vs. gumma, 75. 

gumma, 71. 

syphilitic fissures and ulcers, 
79. 

tertiary lesions, 71. 
Tonsilitis, 83. 
Tonsils, 65, 82. 

chancre, 43, 82. 

epithelioma, 84. 

gumma, 83. 

tuberculosis, 83. 

ulcers, 82. 



Traches, 169. 
Transverse arches, 240. 
Trauma, 66, 241, 246, 248, 250. 
Trichinosis, 250, 252. 
Trigeminal neuralgia, 266. 
Triponema pallidum, 2. 
Trypanosomes, 3. 
Tubercular leprosy, 62. 

syphilide, 61, 63. 
Tuberculin, 81, 250. 
Tuberculosis, 172. 

bacillus, 81. 

gastric, 87. 

glandular, 186. 

hepatic, 107. 

laryngeal, 166. 

lingual, 79, 81. 

nasal, 134, 143. 

osseous, 244. 

pulmonary, 172. 

rectal, 119. 

testicular, 220. 
Tuberculous fissures of tongue, 79. 
Tumors of testicle, 223. 

of penis, 214. 

tongue, 74. 
Tyloma, 61. 
Tympanum, 288. 
Typhoid fever, 246. 
Typhus, 284. 
Tyrosin, 105. 

U 

Ulcer, 51, 60. 

amyloid, 104. 

cancerous, 104. 

duodenal, 104. 

dysenteric, 104. 

embolic, 104. 

laryngeal, 150. 

leprous, 135. 

nasal, 140. 

of intestine, 104. 

of stomach, 86. 

of tongue, 73, 80. 

perforating, 242. 

rectal, 123. 

rodent, 124. 

syphilitic, 60. 

toxic, 104. 

thrombotic, 104. 

tuberculous, 104, 127, 134. 

typhoid, 104. 

venereal, 44. 
Ulcerative endocarditis, 176. 
Ulcerative endocarditis, 178. 
Ulcus elevatum, 38. 

durum, 38. 

gummosum, 38. 

induratum, 38. 

molle, 44. 



422 

Upper jaw, 240, 241, 245, 246. 
Ureter, 198. 
Urethra, 199. 

cancer, 203. 

chancre, 199. 

chancroid, 199, 201. 

gonorrhoea, 200. 

gumma, 203. 

herpes, 202. 

stricture, 201. 

syphilides, 202. 

tuberculosis, 203. 

ulcer, 199. 
Urinary organs, 197. 
Urticaria, 56. 
Uterus, 232. 

cancer, 232. 

chancre, 232. 

chancroid, 232. 

gonorrhoea, 232. 

gummata, 233. 

syphilides, 232. 

syphilitic endometritis, 232. 

tuberculosis, 232. 

ulcer, simple, 232. 
Uvea, 280. 
Uvula, 65. 



Vaccination and syphilis, 35. 
Vaccino-syphilis, 43. 
Vagina, 232. 

chancre, 232. 

gumma, 232. 

syphilides, 232. 
Valves, heart, 174. 
Veins, 179. 



Index. 






Venereal papillomata, 61. 

warts, 61. 
Venillemin, 3. 
Vertebrae, 244. 
Vertebral arches, 240. 

artery, 240. 
Vertigo, 254. 
Villous tumor, 124. 
Villous hypertrophy of synovial 

membrane, 249. 
Virus, 2. 

Visceral affections in the fetus, 35. 
Vitiligo, 57. 
Vitreous, 281. 
Vulva, 226. 

cancer, 229. 

chancre, 227. 

chancroid, 228. 

condylomata, 231. 

elephantiasis, 231. 

lupus, 230. 

tuberculosis, 230. 
Vulvitis, 226. 



W 

Warts, simple, 70. 

venereal, 61, 69. 
Wassermann reaction, 10. 

reaction, "modified," 13. 
Whitlow, 242. 
Whooping cough, 284. 



Yaws, 64. 



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